Eyelash Extensions and/or Keratin Class Enrollment Registration Form

The Lash CEO Lash & Brow Academy

1060 Lynnhaven Pkwy, Suite 111, Virginia Beach, VA 23452 | 757-263-4649
Student Registration Form - Eyelash Extensions & Keratin Lash Lift

Fill out the form completely for registration
Student Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail *
example@example.com
Mobile Number
Company
Desired Month *

September October November December January February
Right or Left Handed *
Have you ever been convicted of a felony other than a traffic citation? *
The Lash & Brow Academy asks for full disclosure to advise students of potential licensing denial. All answers are kept strictly confidential.
Courses *
How did you hear about The Lash & Brow Academy? *
In case of emergency who do we contact? Please list name and mobile number. *
All students are required to have a high school diploma or GED. Please either upload it here or bring a copy when you visit.

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We require an application fee to reserve your enrollment and to build your student kit and supplies assembled. This fee will be deducted from your tuition balance.

USD Enrollment Fee is non-refundable

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The Lash CEO Lash & Brow Academy