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 Modern Manners for Children |
Etiquette & Leadership |
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| Program Location & Time____________________________________________________________________________ | ||
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| Student Information: | ||
| Name First______________________________Middle__________________________Last_____________________________ |
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| Mailing Address____________________________________________________________________________________ | ||
| City___________________________________________State___________________________Zip_________________ | ||
| Telephone Number________________________________________________Birthday____________/_____/________ | ||
| M/F____________Grade_____________School___________________________________________________________ | ||
| Please list any food allergies and/or special requirements: | ||
| _________________________________________________________________________________________________ | ||
| _________________________________________________________________________________________________ | ||
| _________________________________________________________________________________________________ | ||
| Parents/Guardians: | ||
| Father's Name________________________________ Mother's Name____________________________________ | ||
| Address_____________________________________ Address__________________________________________ | ||
| ____________________________________________ ________________________________________________ | ||
| Phone_______________________________________ Phone____________________________________________ | ||
| Email_______________________________________ Email____________________________________________ | ||
| If neither parent can be reached, in case of an emergency, contact: | ||
| Name___________________________________________Phone____________________________________________ | ||
| Relationship_______________________________________________________________________________________ | ||
| Cancellations/Refunds Cancellations must be received seven (7) days prior to the start of a program for full refund. Full refunds will be made in the event that the minimum required enrollment of ten (10) students is not reached. |
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| Parent/Guardian Signature___________________________________________________________________________ | ||
Please make check payable to Savannah Shaw and mail along with registration form to: Savannah Shaw, 2045 Trowbridge Ct., Charlotte, NC 28270 |
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