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Student Enrollment Form
Student Enrollment Form
Enroll here (1)
Please Fill out this form to register your spot for the class and testing. Payments needs to be made by: Cash, Check, or Credit. We do need to receive payment before we can send out your Information and study materials. The sooner we receive the payment the sooner we can get the materials out to you. This will give you time to study the material. We would like you to have the materials in your hands for at least 5 days before the class start date. The study guide is 57 pages in pdf 1.2 meg file. The books will be handed out in class. If you enroll in one of our classes Lunch is provided (6inch sub from Subway and a Drink provided.). There is no additional cost for this lunch it is included. If you have any question please fell free to call me at 601-325-1044
Name of Point of Contact
*
First
Last
Company Name
Email
*
Phone Number we can reach you at.
*
Mobile Number we can reach you at. (optional Information)
Class Date and Location
*
May 11, 2020/Hattiesburg/Monday
May 12, 2020/Jackson/Tuesday
June 8, 2020/Jackson/Monday
June 9, 2020/Hattiesburg/Tuesday
July 13, 2020/Hattiesburg/Monday
July 14, 2020/Jackson/Tuesday
August 3, 2020/Jackson/Monday
August 4, 2020/Hattiesburg/Tuesday
September 14, 2020/Jackson/Monday
September 15, 2020/Jackson/Tuesday
October 12, 2020/Hattiesburg/Monday
October 13, 2020/Jackson/Tuesday
November 9, 2020/Jackson/Monday
November 10, 2020/Hattiesburg/Tuesday
December 7, 2020/Jackson/Monday
December 8, 2020/Hattiesburg/Tuesday
Personal Class
Classes that are not enrolled and paid for 1 week Prior will be subject to a late enrollment fee. ( all classes have to be enrolled and paid for by deadline of the Thursday 5 pm prior week of class.)
Date of Personal Class
Date Format: MM slash DD slash YYYY
Manager ServSafe Certification student #1.
*
YOU WILL RECEIVE A 59 PAGE STUDY GUIDE EMAILED TO YOU UPON COMPLETING THIS FORM. TEXT BOOK IS NOT REQUIRED FOR CLASS. IF YOU PICK WITH TEXT BOOK, TEXT BOOKS WILL BE HANDED OUT DAY OF CLASS.
None
Manager ServSafe Class and Testing (NO BOOK) $30 Discount
Manager ServSafe Class and Testing with Book
Reschedule Fee
Retest Fee (I have taken the test with you and did not receive a passing grade and need to retest)
ServSafe Food Protection Manager Certification Online Class and Testing
ServSafe Food Protection Manager Certification Online Class Only
ServSafe Food Protection Manager Certification One on One Class test
Proctor Fee (I have a ServSafe Class Completion Cert.)
Proctor Fee (I have a ServSafe Class Completion Cert.) OFF SCHEDULE
Personal Class ( This option is to give Contact information to set up a personal class)
Sit in (approved thru instructor)
Manager ServSafe Certification student #1.
*
First
Last
YOU WILL RECEIVE A 59 PAGE STUDY GUIDE EMAILED TO YOU UPON COMPLETING THIS FORM. TEXT BOOK IS NOT REQUIRED FOR CLASS.
Please choose what 6" sub you would prefer for your supplied lunch.
COLD CUT COMBO
TURKEY BREAST
BLACK FOREST HAM
TURKEY AND HAM
ROAST BEEF
SUBWAY CLUB
ITALIAN BMT
SPICY ITALIAN
TUNA
VEGGIE DELITE
This is for us to know what Kind of sub you would prefer during your 30 min lunch break. There will be soda Supplied as well for this lunch. The lunch includes 6" Subway sandwich and a drink. The Sub will come with what you pick above and White American Cheese (not toasted) There will be Lettuce, Tomatoes, Pickles, Banana peppers, Mayo, and mustard on the side. No answer will mean, you will just get what ever random sandwich we may have. If you don't know just pick ANY / I have no preference. Thank you and Enjoy.
Late Enrollment Fee
Price:
$35.00
The last day for enrollment is always the Thursday the week prior to the date of class.
White or Wheat Bread
White
Wheat
If you do not pick white or wheat, we will default of white.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $7.00. This is an option only for retests or sit in's. If this option is not picked default will be No Lunch Provided.
Check if more than 1 student is enrolling
Check here if enrolling more than 1 student
Enrolled student #2
*
First
Last
Manager ServSafe Certification student #2.
*
YOU WILL RECEIVE A 59 PAGE STUDY GUIDE EMAILED TO YOU UPON COMPLETING THIS FORM. TEXT BOOK IS NOT REQUIRED FOR CLASS.
None
Manager ServSafe Class and Testing (NO BOOK) $30 Discount
Manager ServSafe Class and Testing with Book
Reschedule Fee
Retest Fee (I have taken the test with you and did not receive a passing grade and need to retest)
ServSafe Food Protection Manager Certification Online Class and Testing
ServSafe Food Protection Manager Certification Online Class Only
ServSafe Food Protection Manager Certification One on One Class test
Proctor Fee (I have a ServSafe Class Completion Cert.)
Sit in (approved thru instructor)
Late Enrollment Fee
Price:
$35.00
The last day for enrollment is always the Thursday the week prior to the date of class.
Please choose what 6" sub you would prefer for your supplied lunch.
COLD CUT COMBO
TURKEY BREAST
BLACK FOREST HAM
TURKEY AND HAM
ROAST BEEF
SUBWAY CLUB
ITALIAN BMT
SPICY ITALIAN
TUNA
VEGGIE DELITE
This is for us to know what Kind of sub you would prefer during your 30 min lunch break. There will be soda Supplied as well for this lunch. The lunch includes 6" Subway sandwich and a drink. The Sub will come with what you pick above and White American Cheese (not toasted) There will be Lettuce, Tomatoes, Pickles, Banana peppers, Mayo, and mustard on the side. No answer will mean, you will just get what ever random sandwich we may have. If you don't know just pick ANY / I have no preference. Thank you and Enjoy.
White or Wheat Bread
White
Wheat
If you do not pick white or wheat, we will default of white.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $7.00. This is an option only for retests or sit in's. If this option is not picked default will be No Lunch Provided.
Check if more than 2 students is enrolling
Check here if enrolling more than 2 students
Enrolled student #3
*
First
Last
Manager ServSafe Certification student #3.
*
YOU WILL RECEIVE A 59 PAGE STUDY GUIDE EMAILED TO YOU UPON COMPLETING THIS FORM. TEXT BOOK IS NOT REQUIRED FOR CLASS.
None
Manager ServSafe Class and Testing (NO BOOK) $30 Discount
Manager ServSafe Class and Testing with Book
Reschedule Fee
Retest Fee (I have taken the test with you and did not receive a passing grade and need to retest)
ServSafe Food Protection Manager Certification Online Class and Testing
ServSafe Food Protection Manager Certification Online Class Only
ServSafe Food Protection Manager Certification One on One Class test
Proctor Fee (I have a ServSafe Class Completion Cert.)
Sit in (approved thru instructor)
Late Enrollment Fee
Price:
$35.00
The last day for enrollment is always the Thursday the week prior to the date of class.
Please choose what 6" sub you would prefer for your supplied lunch.
COLD CUT COMBO
TURKEY BREAST
BLACK FOREST HAM
TURKEY AND HAM
ROAST BEEF
SUBWAY CLUB
ITALIAN BMT
SPICY ITALIAN
TUNA
VEGGIE DELITE
This is for us to know what Kind of sub you would prefer during your 30 min lunch break. There will be soda Supplied as well for this lunch. The lunch includes 6" Subway sandwich and a drink. The Sub will come with what you pick above and White American Cheese (not toasted) There will be Lettuce, Tomatoes, Pickles, Banana peppers, Mayo, and mustard on the side. No answer will mean, you will just get what ever random sandwich we may have. If you don't know just pick ANY / I have no preference. Thank you and Enjoy.
White or Wheat Bread
White
Wheat
If you do not pick white or wheat, we will default of white.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $7.00. This is an option only for retests or sit in's. If this option is not picked default will be No Lunch Provided.
Check if more than 3 students is enrolling
Check here if enrolling more than 3 students
Enrolled student #4
*
First
Last
Manager ServSafe Certification student #4.
*
YOU WILL RECEIVE A 59 PAGE STUDY GUIDE EMAILED TO YOU UPON COMPLETING THIS FORM. TEXT BOOK IS NOT REQUIRED FOR CLASS.
None
Manager ServSafe Class and Testing with Book
Manager ServSafe Class and Testing (NO BOOK) $30 Discount
Reschedule Fee
Retest Fee (I have taken the test with you and did not receive a passing grade and need to retest)
ServSafe Food Protection Manager Certification Online Class and Testing
ServSafe Food Protection Manager Certification Online Class Only
ServSafe Food Protection Manager Certification One on One Class test
Proctor Fee (I have a ServSafe Class Completion Cert.)
Sit in (approved thru instructor)
Late Enrollment Fee
Price:
$35.00
The last day for enrollment is always the Thursday the week prior to the date of class.
Please choose what 6" sub you would prefer for your supplied lunch.
COLD CUT COMBO
TURKEY BREAST
BLACK FOREST HAM
TURKEY AND HAM
ROAST BEEF
SUBWAY CLUB
ITALIAN BMT
SPICY ITALIAN
TUNA
VEGGIE DELITE
This is for us to know what Kind of sub you would prefer during your 30 min lunch break. There will be soda Supplied as well for this lunch. The lunch includes 6" Subway sandwich and a drink. The Sub will come with what you pick above and White American Cheese (not toasted) There will be Lettuce, Tomatoes, Pickles, Banana peppers, Mayo, and mustard on the side. No answer will mean, you will just get what ever random sandwich we may have. If you don't know just pick ANY / I have no preference. Thank you and Enjoy.
White or Wheat Bread
White
Wheat
If you do not pick white or wheat, we will default of white.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $7.00. This is an option only for retests or sit in's. If this option is not picked default will be No Lunch Provided.
Check if more than 4 students is enrolling
Check here if enrolling more than 4 students
Enrolled student #5
*
First
Last
Manager ServSafe Certification student #5.
*
YOU WILL RECEIVE A 59 PAGE STUDY GUIDE EMAILED TO YOU UPON COMPLETING THIS FORM. TEXT BOOK IS NOT REQUIRED FOR CLASS.
None
Manager ServSafe Class and Testing (NO BOOK) $30 Discount
Manager ServSafe Class and Testing with Book
Reschedule Fee
Retest Fee (I have taken the test with you and did not receive a passing grade and need to retest)
ServSafe Food Protection Manager Certification Online Class and Testing
ServSafe Food Protection Manager Certification Online Class Only
ServSafe Food Protection Manager Certification One on One Class test
Proctor Fee (I have a ServSafe Class Completion Cert.)
Sit in (approved thru instructor)
Late Enrollment Fee
Price:
$35.00
The last day for enrollment is always the Thursday the week prior to the date of class.
Please choose what 6" sub you would prefer for your supplied lunch.
COLD CUT COMBO
TURKEY BREAST
BLACK FOREST HAM
TURKEY AND HAM
ROAST BEEF
SUBWAY CLUB
ITALIAN BMT
SPICY ITALIAN
TUNA
VEGGIE DELITE
This is for us to know what Kind of sub you would prefer during your 30 min lunch break. There will be soda Supplied as well for this lunch. The lunch includes 6" Subway sandwich and a drink. The Sub will come with what you pick above and White American Cheese (not toasted) There will be Lettuce, Tomatoes, Pickles, Banana peppers, Mayo, and mustard on the side. No answer will mean, you will just get what ever random sandwich we may have. If you don't know just pick ANY / I have no preference. Thank you and Enjoy.
White or Wheat Bread
White
Wheat
If you do not pick white or wheat, we will default of white.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $7.00. This is an option only for retests or sit in's. If this option is not picked default will be No Lunch Provided.
Coupon Code
Total
$0.00
This is the total cost for what you have selected.
Check the box below if you have read the Terms & Conditions
*
I have read and accept the terms & conditions
Terms & Conditions
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Click below if enrolling after last day of enrollment
Check here if enrolling after Thursday the week before class.
The last day for enrollment is always the Thursday the week prior to the date of class. For the free lunch we provide is only for students enrolling by Last day of enrollment.
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Check / 6068 HWY. 98W Suite 1-315 Hattiesburg, MS. 39402
Magic System (Vendor / Supplier number 3102000325)
If you are Paying by cheque. Please make your cheque out to: Mike’s Food Safety Class LLC. Please send your cheque to: Mike’s Food Safety Class at 6068 HWY. 98W Suite 1-315 Hattiesburg, MS. 39402.
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