Application For Courses
Please Print & Mail With Check, Money Order, Credit Card Information

Name: ____________________________  DOB: _____________

Address: ______________________________________________

    ______________________________________________

    ______________________________________________

Phone: ____________________________ Cell: _______________

License Type: ______________________ Lic. No.: ___________

Master/Visa Card #: ____________________________________

Expiration Date: ________________________________________

Course of Interest: ______________________________________

Amount Enclosed: __________________ Course Date: _________

E-Mail: _______________________________________________

Employer: _____________________________________________

Employer Phone:________________________________________

Do you have any physical limitations or disabilities?  ❑ Yes      ❑ No   
If so, please indicate below any limitations, disabilities, or special accommodations.  

Are you pregnant?   ❑ Yes      ❑ No
______________________________________________________

______________________________________________________

______________________________________________________
Dreamscape Day Spa Training, Inc.
(254) 652-5940
Please mail to:

Dreamscape Day Spa, Inc.
15335 Wortham Bend Rd.
China Spring, TX 76633