Enrollment Form

   Mother's Full Name ___________________________ Father's Full Name _______________________

   Address __________________________ City _______________ State ___________ Zip __________

   Home Phone __________________ Cell Phone ________________ Work Phone ________________

   Emergency Contact ______________________________________ Phone ______________________

   Email ______________________________________ Age _______ Birthdate ____________________

   List any food allergies or special accommodations required ___________________________________

   __________________________________________________________________________________

   Consent for medical treatment and disclaimer:

I acknowledge that I am the parent and/or legal guardian for the above applicant. I hereby give my consent for emergency medical care prescribed by a licensed physician and/or licensed paramedic. This care may be given under any condition necessary to preserve the life or well being of my child. I hereby release, discharge and otherwise indemnify Karis Etiquette, its employees and all associated personnel, against any claim by or on behalf of the registrant as a result in the registrant’s participation in a Karis Etiquette program.

   Name Print ______________________________________________________ Date ____________________________

   Name Sign ______________________________________________________ Relationship ______________________

I have enclosed my tuition deposit for half the amount of full tuition to hold my student’s place. I understand that deposits cannot be refunded 30 days prior to the start of my chosen class and that the tuition balance is due at the beginning of the first class day.

Please print a hard copy of this form, fill out completely, sign, date and remit along with payment to
P.O. Box 433 Grapevine, Texas 76099. Forms of payment excepted are cash, money order or check
(if final payment is made by check it must be received 10 days prior to class start date).

Gift certificates are available for both children and adult classes. What better gift to give than the knowledge of etiquette...The gift that last a lifetime!

For additional information on my services, please feel free to contact me directly.
Thank You ~ Denise Ludwig