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COSMETOLOGY TRAINING CENTER
5303 N. Market Spokane WA, 99217
Registration
Application
Date ________________________________
Name _______________________________
Address ___________________________________________________________________________________
Social Security # ______________________
Phone # _____________________________
Date of birth _________________________________
Emergency phone # ___________________________
Medical Information
Do you take any medication? ______________
Are you allergic to any type of medication? ____
Type _______________________________________
Type _______________________________________
Do you have any medical problems? ______________________________________________________________
Doctors name and phone # _____________________________________________________________________
Hospital preferred ____________________________________________________________________________
Education
High School _________________________________
College ___________________________________
Have you attended a beauty school in the past? _____
Name of school ______________________________GED ______________________________________
Years attended ______________________________
Hours completed ____________________________
Phone _____________________________________
Address ____________________________________________________________________________________
Other Schools attended since High School
____________________________________________________________________________________________
____________________________________________________________________________________________
Current Place of employment _____________________________________________________________________
Phone # __________________________
Student signature _____________________________________________________________________________