Mental Wellness Nail Art Series Registration

Mental Wellness Art Series

For Young Adults with Disabilities
Student Information
Name*

First NameLast Name
Age*
Gender*

MaleFemaleNonbinary
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Phone Number
Email
example@example.com
Relationship
Other
How do you learn about this online art class?*

FacebookTwitterInstagramYouTubeSearch EngineOnline AdsReferralOther
I agree to participate in the Mental Wellness Art Series and attend all 6 classes*

Yes
Signature of Student*

Clear
Date Signed*

MonthDayYear
Date
Parent/guardian Signature

Clear
Date Signed

MonthDayYear
Date
The relevant links will be provided in the autoresponder email after you successfully registered.

If you have any questions, please email or call us using the details below:

Nail Dega DBA Beauty Business Lab
info@naildega.com
(310) 908-0033
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Mental Wellness Art Series