SRVCA Registration

    Select Class*

    Student Name*

    Gender*

    malefemale

    Address*

    City/Zip Code*

    Email*

    Home Phone*

    Dietary or Health Restrictions

    How did you hear about us?

    FOR MINORS

    Date of birth

    Grade

    School

    Parent/guardian name(s)

    Parent guardian cell phone number

    Additional emergency contact name/number

    Persons authorized to pick up your child

    WAIVER OF LIABILITY (required)

    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:

    JILL PFEIFFER ETIQUETTE SCHOOL POLICIES

    Course Cancellation:

    When 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 mail@jillpfeiffer.com

    Withdrawals/Refunds:

    Requests for withdrawals must be submitted in writing to mail@jillpfeiffer.com. 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 $5 withdrawal 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*: