MYM Registration Form

Child 1 Name *

First

Last

Title Preference *

Child's Age *

Grade *

I am registering my child for: *

My child is allergic to / has special needs *

School your child attends *

Alumnus/Alumna *

We photograph and/or videotape some classes *

I allow my child's picture to be used in promotional material Please do not post any pictures of my child publicly

Address *

Line 1

Line 2

City

State

Zip Code

Country

Would you like to receive our monthly newsletter *

Yes, please. I love etiquette tips and learning about new programs No, thank you. I receive too many emails already

Topics that interest me the most are: *

Etiquette tips for kids Programs for kids Etiquette tips for professionals Professional programs for adults

Your goals for your child and/or additional comments *

Registration for
Mind Your Manners {grades 2-5}