Date

MM

DD

YYYY

Name

First Name

Last Name

Gender

Male

Female

Date of Birth

School

Contact in Case of Emergency

First Name

Last Name

Phone

(###)

###

####

Email Address

Right or Left Handed

Food Allergies or Intolerances

Dietary Restrictions

PHOTOGRAPHY PERMISSION AND RELEASE

I agree to allow Proper Way Academy to take photograph and/or videotape my children 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
Debit or Credit Card (link to pay will appear in the invoice. A processing fee of 3% will be applied if paid with Credit Card)