Step 1: Register

Select Class*

Student Name*


Age Group*


City/Zip Code*


Home Phone*

Dietary or Health Restrictions

How did you hear about us?


Date of birth



Parent/guardian name(s)

Parent guardian cell phone number

Additional emergency contact name/number

Persons authorized to pick up your child

I am the class participant, or the parent/guardian of the class participant named above, and do hereby waive, release, and discharge all claims for damages, personal injury, and property damage which I may have or which may hereafter accrue to me as a result of participation in the class selected. I understand that accidents can occur during class. Knowing the risks of the class, I hereby agree to assume those risks. This release is intended to discharge and hold harmless Jill Pfeiffer Etiquette School LLC, its officers, and employees from liability. I further understand that photographs and videos may be taken of the class participant during the course of the said activity, and that these photographs and video may be used for Jill Pfeiffer Etiquette School promotional purposes. No child will be identified by name in pictures and videos used by Jill Pfeiffer Etiquette School.
By checking this box, I acknowledge that I have read, understood, and agree to the Waiver of Liability*
Full Name:


Course Cancellation:
When class registration does not meet the minimum enrollment required, it may be necessary to cancel a class. At the time of cancellation, Jill Pfeiffer Etiquette School will initiate a full refund. Class refunds may take two weeks to process.

Wait Lists:
A wait list will be established once a class has reached maximum enrollment. If you would like to be added to a wait list, please submit your request in writing to

Requests for withdrawals must be submitted in writing to Phone requests will not be honored. Requests for withdrawals will be honored, if requested in writing, no later than seven (7) business days prior to the first day of class. Requests for Refund/Withdrawal fewer than 7 business days prior to the first class will only be honored if the spot can be filled by another student before the class commences. A $10 administrative fee will be assessed to all withdrawal requests.

By checking this box, I acknowledge that I have read, understood, and agree with the policies of Jill Pfeiffer Etiquette School LLC.*

Authorized By*: