Name *

First Name

Last Name

Phone

(###)

###

####

SERVICES

Please select the services that you are licensed to perform (Check ALL that apply)

Hair Styling (Cut/Wash/Style)

Facials

Eyebrows

Manicures

Hand Massages

Chair Massages (Neck/Shoulder)

YOUR AVAILABILITY

(Check ALL that apply)

Mondays (10:00am-12:00n)

Mondays (3:00p-5:00p)

Tuesdays (10:00am-12:00n)

Tuesdays (3:00p-5:00p)

Thursdays (10:00am-12:00n)

Thursdays (3:00p-5:00p)

Fridays (10:00am-12:00n)

Fridays (3:00p-5:00p)

Saturdays (10:00am-12:00n)

Saturdays (3:00p-5:00p)

iTEMS NEEDED TO PERFORM SERVICES::

(Check ALL that apply)

Sink

Chair

Table

Towels

Washcloths

Tissue