ENROLLMENT APPLICATIONStudentStudent2102006-05-09T22:02:00Z2006-05-13T00:34:00Z1135773Beauty School6190711.6568

ENROLLMENT APPLICATION

HARMON’S

BEAUTY

SCHOOL

7760 LANDOVER ROAD

LANDOVER

20785

301-772-2244

STUDENT NAME:

AGE:

D.O.B.

ADDRESS:

CITY:

STATE:

ZIP:

PHONE NUMBER (HOME):

WORK:

SSN:

EMAIL ADDRESS:

DRIVER LICENSE NO:

EMERGENCY CONTACT:

HOME#:

WORK#: #:

FAMILY DOCTOR:

PHONE#:

PARENTS NAME:

PHONE#:

EDUCATION

HIGHEST GRADE COMPLETED:

HIGH SCHOOL ATTENDED:

COURSES:

OTHER TRAINING:

COLLEGE ATTENDED:

COURSES:

DATE GRAD.:

COURSES:

DATE GRAD.:

COURSES:

DATE GRAD.:

OTHER TRAINING:

COURSES:

DATE GRAD.:

RELEASE FORM

I HEREBY AUTHORIZE

its owners, agent employees or representative to release my student records

DATE:

STUDENT NAME

STUDENT SIGNATURE

WITNESS: