Register

Registration

, Please complete the form below or print and mail the form to the address below with 50% deposit to secure registration.
Lisa Butowsky ~ Your Charming Child
2541 Peachtree Drive
Perkasie, Pa 18944

Deposit made via cash, check, money order and Pay Pal. Credit Cards accepted for balance at class time. Refundable depending on circumstances.

*Please register at least 48 hours in advance of class date ~ thank you.

your_charming_child_registration_form.pdf
File Size:	64 kb
File Type:	pdf

Download File

Email us with any questions at lisa@yourcharmingchild.com

Your Charming Child Registration Form

* Indicates required field

Parent's Name *

First

Last

Child's Name *

First

Last

Child's Date of Birth and Current Age *

Parent's Email *

Parent's Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Child's Gender *

Male Female Prefer not to say

Can the child read and write *

Yes No

Food/Other Allergies *

Program(s) Desired *

Social Skills Communication Skills Dining Etiquette

Session Date Desired *

Back-up Date *

Questions or Concerns *

Submit

Friends and good manners will carry you where money won't go.

~Margaret Walker, Poet and writer

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Your Charming Child~Etiquette Instruction

Send us an email
Lisa@YourCharmingChild.com

Give us a call
215-453-1432