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Thank you for visiting ETIQUETA EXCELLENCE MANNERS website. Please fill out the following form to request information about our products and services or to provide feedback about our site. When you are finished, click the 'Submit' button to send us your message. You will see a confirmation below.



REGISTRATION FORM - Please print, fill out and mail with payment to:

Yvonne Salas P.O. Box 820851, Pembroke Pines, Florida 33082

 

Etiqueta Excellence Manners

 Registration Form

Child’s First & Last Name : ___________________________________________

Home Address:____________________________________________________

Age______ Grade______Name of School________________________________

Sports/Activities____________________________________________________

Allergies?___Yes______No explain:

Parent’s First & Last Name: ___________________________________________

Phones:H_____________________Cel_________________Work____________________

Email: ___________________________________________

In case of emergency contact:

Name: __________________________

Relationship: ___________________

Phone: ________________

Person (s) authorized to pick up your child:

( ) Check if same as emergency contact

Name: __________________________

Relationship: ___________________

Phone: _______________

How did you hear about our program?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

I authorize my child to be photographed in the classroom and his image used for the promotion of our programs on our website and other websites. Yes ( ) No ( )

Name:_________________________________Signature:_______________________________

Date:________________________________

*Parents & legal guardians assume responsibility for any harm that the child may cause others or to private property where class is held or of the other students.

Class Start Date:_____________________________

To reserve your space, payment must be received with registration.

www.etiquetaexcellencemanners.com

www.etiquetaexcellencemanners.blogspot.com

Broward: 954-655-8820 Palm Beach: 561-255-0549

 

 


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