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Registration Form 2011 - 2012 Classes

The Etiquette School

FOR OFFICE USE ONLY RF Rec'd ___________________________ FP ________________________________ SP ________________________________ SF ________________________________

To Be Completed by Parent/Guardian

Student Information

*Need complete name for the Spring Formal Program

Partner __________________________

First _____________________________ Middle _____________________________ Last ____________________________ Name Called: _____________________________ Mailing Address ________________________________________________________________________________________ City ____________________________________________ State ___________________________Zip __________________ Telephone Number (_______) __________________________ Birthday __________/__________/__________

Age ___________ Grade ___________ School ______________________________________________________________ Sibling(s) name and grade in school: ________________________________________________________________________ Please list any special information we may need in teaching your child: ____________________________________________ _______________________________________________________________________________________________________ Father's Name ________________________________________ Mother's Name ____________________________________ Address _____________________________________________ ____________________________________________________ Address _________________________________________ ________________________________________________

Phone (w) ___________________________________________ Phone (w) _______________________________________ Phone (h) ___________________________________________ Fax (w) _____________________________________________ Phone (h) _______________________________________ Fax (w) _________________________________________

Fax (h) ______________________________________________ Fax (h) _________________________________________ E-mail _______________________________________________ E-mail __________________________________________ If neither parent can be reached in case of emergency, please contact: Name _______________________________________________ Phone __________________________________________ Name _______________________________________________ Phone __________________________________________ Please mail as soon as possible to insure your young person's place in a class. Remember to get a partner. Please turn over to complete form.

Perfectly Polished, Inc. · Post Office Box 6073 Athens, Georgia 30604 ·

706-769-4191

e-mail: [email protected] · [email protected] · [email protected] www.perfectlypolished.com

SOCIAL I

LOCATIONS (Please check one): Rocky Branch Elementary............................Mondays beginning Sept. 12

SOCIAL II

LOCATIONS (Please check one): Athens YMCA ..............................Sundays beginning Sept. 11

High Shoals Elementary ...............................Wednesdays beginning Sept. 14 First UMC, Madison .....................Sundays beginning Sept. 11 Athens YMCA Track A...............................Sundays beginning Sept. 11 Athens YMCA Track B................................Sundays beginning Sept. 18 Madison, GA Methodist Church ...............Sundays beginning Sept. 11 Oconee Elementary .......................................Tuesdays beginning Sept. 13 Malcom Bridge Elementary..........................Thursdays beginning Sept. 8 Social I High School......................................Sundays beginning Sept. 18 Colham Ferry Elementary.............................Wednesdays beginning Sept. 14 Oconee Co. Middle School .........Mondays beginning Sept. 12 Malcom Bridge Middle.................Thursdays beginning Sept. 8

DANCE CLUB

Athens YMCA ..............................Sundays beginning Sept. 18

COTLLION CLUB

Athens YMCA ..............................Sundays beginning Sept. 11

LEAD DANCE

Beginning ............................................Saturday, September 10

CRITICAL REGISTRATION INFORMATION: Social I Registration requires partners. If you register with a partner you are automatically confirmed for the class. If you do not register with a partner, registration is on a first come first served and by gender basis. Your name will be placed on a waiting list in order to insure equal members of ladies and gentlemen. Handshakes, introduction skills, dining skills and dance are all taught using partners. Equal number of ladies and gentlemen insure full participation. TUITION: $225.00 For Social I and Social II $250.00 For Dance Club, Cotillion Club and Lead Dance

A class runs 16 weeks from September to March and is a year long program ending with a Spring Formal for all students on March 24, 2012 at the UGA Coliseum. Note: Weekday classes meet every week while Sunday classes meet every other Sunday. This is a September through March class and our policy includes no refunds. A minimum class enrollment of thirty students is required for each class. Tuition is to be included with this form to insure your child's place in the class. For your convenience, you may pay $125 with this registration and pay the balance by December 1, 2011 (checks only). Credit card tuition must be in full. Method of payment: (check one) Check Visa MasterCard For charges: Name as it appears on the card ____________________________________________________________________ Number ____________________________________ Expiration date ___________________ Amount _________________ Parent's Signature ______________________________________________________ Date ___________________________

Film, Photography, Website Release Form

In the event that there is either any print or electronic media coverage during the Perfectly Polished program, permission is hereby granted to use any photograph or video of likeness of the student in any manner, without obtaining subsequent permission or consent and without payment of further consideration. I agree to defend, indemnify, and hold Perfectly Polished harmless from and against any claim, demand or cause of action that I may make because of the use of any such photograph or likeness in any manner. I understand that photograph WILL NOT have any person identified by name.

Parent or Guardian's Name ______________________________________________________

Date _______________________

TO REGISTER COMPLETE FORM ON BACK

Information

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