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Registration

We are excited about your interest in applying to the Kimo Bentley Esthetics Academy. Please fill out the information in the form.

240-476-3540

info@kimobentley.com

First Name

Last Name

Email

Phone

Select an Address

Education - a copy of each document must be provided *

HS Diploma

Associate Degree

Bachelors Degree

Schools attended

Emergency Contact(s)

Legal resident of the United States

Are you considering day or evening classes

Do you currently work?

How will you pay for the program?

What career interest you?

When are you able to start class?

Do you have any physical limitations that will interfere with you performing any work in your chosen profession? (If yes, please explain)

How did you hear about us?

Your Signature

Thanks for submitting!

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