Class Registration For Former Student

Student Name

First Name

Middle Name

Last Name

Gender

Male Female

Student Age

Student E-mail

Student Phone Number

Can student receive text message updates?

Yes No

What style/technique do you struggle with most? *

Are you considering hair braiding as a skill that could shape your future personal lifestyle or entrepreneurial ventures or Both?

Parent/Guardian Name

First Name

Middle Name

Last Name

Relationship to Student

Work Phone Number

Mobile Phone Number

Address

Street Address

Street Address Line 2 (Optional)

City

State / Province

Postal / Zip Code

Who will pick student up at the end of class?

Relationship to Student

Full Name

Phone Number

Allergies?

Yes No

If yes, please list Allergies here:

Media Release

Yes, I give permission to allow photos of my child to be used by Omot Foundation media and marketing materials. No, I do not give my permission to allow photos of my child to be used by Omot Foundation.

Today's Date

Class Registration For Former Student

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