Sensory Safe Provider Form

Sensory Safe Provider Form

Please fill out application form to be displayed as a service provider.
Full Name*

First NameLast Name
Address (Where you will provide service)*
Email*
example@example.com
Your Sensory Safe decal will be mailed to you — place it in your shop or salon window to let clients know you’re a certified Sensory Safe Provider.

I’d like a printed copy of my certification mailed to me.(You’ll receive a digital certificate by email after class completion — we’d love to save a tree if possible!)
Profession (Primary)*

BarberStylistNail TechMassage TherapistEstheticianAestheticianBraiderAmbassador
Phone Number*
Please enter a valid phone number.
Instagram / YouTube / Other Portfolio Link*
Where people can see your "work"
Should be Empty: