Esthetician Registration Form

Please take a moment to fill out the form.

First Name

Last Name

Phone

Street Address

City

State

Postal / Zip code

Birthday

Social Security Number

Emergency Contact

Relation to student

Emergency Contact Phone Number

Academic Record

High School

Address

Year of Diploma

Highest Level of Education

By registering with The LBL Beauty Academy, I realize that I'm enrolling in an Cosmetology Academy. I have been given an understanding of the tuition, late fees, and return policy. I also realize that I'm responsible for my education in attending theory classes and practical requirements to be successful in my program. I will commit to completing written and practical exams as well as the required hours to complete my program.

Your Signature

Have you ever been convicted of an offense other than a minor traffic violation? If yes, please provide an explanation including the nature of the offense and action taken. The LBL Beauty Academy asks for full disclosure as this incident could result in licensing denial. The information is kept in the student confidential file.

Thanks for submitting!