Elementary Manners Application

Elementary Manners 101 Application

Welcome to the Elementary Manners 101 event for July 12, 2022.
Event will be held at the Arvest Conference Room on the Bentonville Square from 9:00am to 12:00pm.
Please make sure you note any food allergies or restrictions on the form before submitting as we will have some snacks during our event.

Please fill out and submit the application by hitting the button at the bottom of the page.
Class fee is $40.00 and includes snacks and all materials. If paying by check, you may mail a check with student's name in memo line to BRJC, P.O. Box 481, Centerton, AR 72719. The director will confirm with you after receiving the online application as well, so that you know that it has been received.
Please note that online payments will have $3.00 processing fee included.

Elementary Manners 101 Application

* Indicates required field

Child's Name *

First

Last

Name Called *

Age *

Upload Child's Picture (For director to learn names) *

Max file size: 20MB

School Name and Grade (Fall 2022) *

Food Allergies or Restrictions and Important Info *

Mother / Custodial Parent 1 *

First

Last

Select Title *

Cell Number *

Email *

Father / Custodial Parent 2 *

First

Last

Select Title *

Cell Number *

Email *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Additional comments *

Submit Application

PLEASE BE SURE TO FILL OUT ALL REQUIRED FIELDS BEFORE CLICKING THE "SUBMIT APPLICATION" BUTTON.

PLEASE PRINT THIS APPLICATION FORM BEFORE PRESSING "SUBMIT" BUTTON.

If mailing application, please submit to: BRJC, P.O. Box 481, Centerton, AR 72719
Checks may be mailed to the address above. Please indicate on application if paying by check.
Please note that online payments will have $3.00 processing fee included.