Date

MM

DD

YYYY

Name

First Name

Last Name

Gender

Male

Female

Day and Time of Attendance

Please let us know Day and Time you would like to attend.

Date of Birth

MM

DD

YYYY

Grade

School

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact in case of emergency

First Name

Last Name

Phone

(###)

###

####

Email Address

Right or Left Handed

Food allergies or intolerances

Dietary Restrictions

Has the child attended any lesson like this before? (Ex. Cotillion)

Where did you hear about us?

PHOTOGRAPHY PERMISSION AND RELEASE

I agree to allow Proper Way Academy to take photograph and/or videotape to be used for the company marketing purposes.

Yes

No

Name

First Name

Last Name

Date

MM

DD

YYYY

Payment forms accepted

Cheque (written to Proper Way Academy)
Venmo (@Monica-Herrera-67) and Zelle
Debit or Credit Card (Let us know if you would like to pay this way and we will send a link to pay in the invoice. A processing fee of 3.11% will be applied if paid with Credit Card)
Cash