First Name:*

Last Name:*

Date of Birth*

Email:*

Cell Phone Number:*

Alternate Phone Number:

Please contact me by:*

Street Address 1:*

Street Address 2:

City:*

Province:*

Postal Code:*

Are you a Canadian Citizen or Permanent Resident of Canada?*

Which program are you applying for?*

Desired Start Date:*

By submitting this form you permit Hair Design Centre to contact you about the program and school. You may opt out at any time.*

Application