14300 Cornerstone Village Dr. Ste 226 Houston, Tx 77014
Phone: 832-286-4271 Email: beauty@dhiesthetics.com
School Registration Application
Please allow 24-48 hours for a response. Thank You!
Full Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person
First Name
Last Name
Emergency Phone Number
Please enter a valid phone number.
Health History
If the student have any allergies, please list them down below:
Does the student have any medical conditions that you would like to declare?
Highest Grade Completed
*
Have you ever been convicted of, entered a plea of guilty, no contest, or had a withheld judgement to a felony? Yes or No, If yes, please explain.
*
Have you decided how you would like to finance your education?
*
Pay in full
Tuition Installment Plan
Deposit Installment Payment Plan
Have you attended cosmetology/beauty school before? (if so, where?)
*
Do you have potential hours/credits that you want to transfer over?
*
Desired start date
*
-
Month
-
Day
Year
Date
Course Interest
*
Esthetician Program
Future Programs
Why are you interested in this program?
*
*NON REFUNDABLE REGISTRATION APPLICATION FEE OF $50 REQUIRED TO PROCESS THIS APPLICATION. I am an authorized user of the card entered to pay the NONREFUNDABLE registration fee and will NOT dispute the payment with my credit/debit card institution; so as long as the transaction corresponds to the terms indicated in this form. (Please type OK and YOUR NAME in the box below)
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
My Products
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( X )
Registration Fee
Non-Refundable
$
50.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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