Today’s Date:	
Student’s Name:	Student’s Age:	
Student’s Name:	Student’s Age	
Workshop Date and location you wish to attend:	
Parent’s Name:	
Mailing Address:	Phone:	
Postal Code:		
Email address:		

Emergency Contact:                                                                 Phone:		
I found out about the session from: a friend __ radio __ TV __ newspaper ___ website __ 
Other (please specify) ____________________________________________________	
Food allergies:                                                                      (we have a snack and beverage during a session)	
From time to time, we receive calls from the media to interview or quote past participants/parents. May we contact you?  Yes ___   No ___	
Parent Signature:	

*	
Please call 1-866-696-1666   or 416-648-3624 to reserve your spot and 
then mail this registration form with a cheque payable to: 
The Etiquette Ladies
82 Jarvis St. Orillia, ON L3V 2A3
Or make payment through PayPal

You will receive a confirmation call when processed.
Thank you for investing in the life of a child!

For Office Use
Session Date: _____________________		Start time: ___________________

Location: ________________________ 		End time: ___________________
Payment received: _________________ 		Confirmation call complete: _____