(Please print and mail to address below)
Please register at least 48 hours in advance of class date ~ Thank you!
Child(ren)’s Name(s) and Age(s):
Can he/she/they read and write?
Food/other Allergies (please include examples of foods he/she CANNOT eat):
Program(s) Desired (please check all that apply):
Social Skills (2 hours) __ Communication Skills (2 hours) __
Dining Etiquette (2 hours) __
Session & Date Desired (please provide back-up date in case class is full):
1. _____________ 2. ____________
Questions or concerns:
How did you hear about Your Charming Child?
From time to time we would like to capture the fun the kids have during class. Are you OK with your child's photo possibly being taken and included on our website or in other PR materials (e.g., newspaper, brochure)? It will show other parents what a class is like and can help our business grow. This would be for our use only and we would not sell or share it with others.
Yes ___ No ___
Thank you for completing this form!
Please mail form and deposit (made out to Lisa Butowsky) to:
Lisa Butowsky ~ Your Charming Child
26 Endslow Lane
Perkasie, PA 18944
Cash, check or money order only please. Sorry, no credit cards accepted.
"Friends and good manners will carry you where money won't go."
~ Margaret Walker (poet and writer)