Enrollment

Full Name

Street Address

City, State, Zip

Telephone

Your email

Place of Birth

Age

Date of Birth

Emergency Contact

Emergency Telephone

Right or Left Handed
right handedleft handed

Vest Size
S/MM/LX/L2X3X4X

Name on your Vest (preferred spelling)

Do you have a minimum of a tenth grade education? If yes, please supply the name of the school, city and state where school is located and dates of attendance:

Have you ever attended a barber college before? If yes, please supply the name and location of the school:

Do you have a current Arizona Cosmetology License?

Planned Start Date

Signature (By completing and submitting this form, you hereby acknowledge that all information is true and factual)