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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 60 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. 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 to best reach you.
*
Mobile Number to reach you. (optional Information)
Class Date and Location
*
October 11, 2021/Hattiesburg/Monday
October 12, 2021/Jackson/Tuesday
November 15, 2021/Hattiesburg/Monday
November 16, 2021/Jackson/Tuesday
December 13, 2021/Jackson/Monday
December 14, 2021/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 60 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.
Lunch will be Provided For our Hattiesburg and Jackson classes
I do want lunch
I do not want lunch
We will have lunch provided. For Hattiesburg class-You will be given a lunch ticket at time of class which will have the following options: Burger, Burger with cheese, Chicken Sandwich, Salad w/ choice of dressing, Sweet Tea, Water. Lunch is Free. If you pick you do not want lunch it will not lower your cost of class. For the Jackson Class Lunch will also be provided.
Late Enrollment Fee
Price:
$35.00
The last day for enrollment is always the Thursday the week prior to the date of class.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $9.00. 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 60 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.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $9.00. 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 60 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.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $9.00. 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 60 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.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $9.00. 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 60 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.
Lunch for Retests or sit in.
Lunch Provided
No Lunch Provided
Lunch cost is $9.00. 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
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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.
Choice of Payment
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Credit Card
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Check / 664 Epley Rd Hattiesburg, MS. 39402
Magic System (Vendor / Supplier number 3102000325)
If you are paying by check, please make your check out to: Mike’s Food Safety Class LLC. Please send your check to: Mike’s Food Safety Class at 664 Epley Rd Hattiesburg, MS. 39402.
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