Registration
First Impressions Consulting
Carol Holland, Executive Director
(615) 599-2640
email cmh56@comcast.net In order to reserve placement in the program, please complete the following registration
form and send to the email above or request US Postal address by email above.
Confirmation is furnished upon receipt of registration.
~~~~SPACE IS LIMITED!~~~~
Registration Information
Session or Class:_______________________
Date:_________________________________
Name (Miss/Mr.)_________________________________________________
Age______________________ Birthdate_____________________________
School___________________________ Grade________________________
Parents_______________________________________________________
Address_______________________________________________________
City _____________________________________ Zip__________________
Phone (home)__________________________(cell)_____________________
Email_____________________________________
Describe your child______________________________________________
Parent priority/expectations________________________________________
_____________________________________________________________
IMPERATIVE Please list any food allergies____________________________ or special needs_____________________________________
How did you learn of our program?___________________________________
Please (include / do not include) us on your mailing list for notification
of class offerings. (circle one)
Thank You for Your Patronage!