Personal Information
• Full Name:
• Date of Birth: / _ / _
•Phone Number:
• Email Address:
• Home Address:
• City: __
• Province/State:
• Postal Code: _
Emergency Contact
• Full Name:
• Relationship:
• Phone Number: __
Course Information
Which course would you like to enroll in?
☐ Basic Esthetics ☐ Avance esthetics
☐ Dermapen
☐ Laser treatments
☐ Chemical Peels
☐ Microblanding/Permanent Makeup
☐ Facials
☐ Waxing
☐ Lash Lift & Tint ☐ Botox
☐ Other: __
Preferred Start Date:
⸻
Preferred Schedule:
☐ Morning
☐ Afternoon
☐ Evening
☐ Weekend
Previous Experience
Do you have any previous experience in aesthetics?
☐ Yes
☐ No
If yes, please describe:
⸻
Payment Information
Preferred Payment Method:
☐ Cash
☐ Debit/Credit Card
☐ E-Transfer
☐ Payment Plan
Agreement
I certify that all the information provided is true and accurate. I understand that submitting this form does not guarantee enrollment until payment and acceptance by the school have been confirmed.
☐ I agree to the Terms & Conditions.
Student Signature:
⸻
Date:
_ / _ / __
⸻
Please print, complete and sign this registration form, then email it to: TANIAMEDISPA@HOTMAIL.COM