Child Intake & Style Inspiration
Welcome! Please fill out the following information to help us understand your child's hair needs and style preferences.
Parent/Guardian Name
*
First Name
Last Name
Child's Name
*
Child’s Date of Birth (for birthday promotions & growth tracking)
*
-
Month
-
Day
Year
Date Picker Icon
Child’s Age (Auto-Calculated)
Parent Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Is your child tender-headed?
*
Yes
No
Any scalp concerns?
*
short hair/breakage
alopecia
sensitive scalp
none
Other
Any Allergies
*
Upload Child 1 – Current Hair Photo
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Child 1 – Inspiration Photo (optional – only if requesting a custom hairstyle or style quote)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Submit
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