POLKA DOT SOCKS
Student Registration Form

Before completing the registration form below, please take a moment to review the Student Commitment Form. Each student and parent will be asked to sign this form prior to session #1
LAST NAME
City
ST
School
Phone #
Email Address

ADDITIONAL
COMMENTS
First Name
PLEASE NOTE: 
Students must commit to attending all 10 Polka Dot Socks sessions and commit to attending for the entire 2-hour session. Photography and videography will be taken during each session. Your registration for Polka Dot Socks provides consent for your image to be used in all marketing and media materials produced by I Am A Gentleman, Inc. Parents or legal guardians must accompany their students to the first day of Polka Dot Socks on Saturday, September 22, 2018 and both must be prepared to sign a copy of the Student Commitment Form.
Birthdate
Current Age
How did you hear about 
Polka Dot Socks?
Please share with us why you would like to be a part of Polka Dot Socks
Are you a graduating high school senior?
Did you review the Student Commitment Form before completing your registration?
If no, please click here before proceeding
If friend, please list their name here:
Which session are you registering for?
HOBBIES
If other, please list here
Dress Shirt Size
Dress Pants Size
YESNO
YESNO
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