Rozell’s Nails Academy

$100 Registration Fee (non-refundable)
Rozell’s Nails Academy

Registration Form
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of birth *

MonthDayYear
Date
Driver’s License or ID Number*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Which course are you interested in?*

Full-time (7-week course)Part-time (11-week course)
Which did you receive?*

High School DiplomaGEDStill in high school
If you are still in high school, what grade are you in?
Do you have any experience in the nail industry?*

YesNo
Do you have any license?

YesNo
If yes, what kind?
How did you hear about us?
Today’s Date*

MonthDayYear
Date
Signature*

Clear
Parent/Guardian Signature (if under 18 years of age)

Clear
*Upon approval please bring your driver's license or ID, birth certificate, diploma or school transcript.
Should be Empty: