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Body TuneUp School of Massage

Welcomes you on Your Path to a Fulfilling Career in Massage Therapy!

STUDENT PRE-APPLICATION 500 HOUR CORE CURRICULUM

Name:                                                                                                         Date:                  
(Last)                                         (First)                                         (Middle)

Address:                                                                                                                                 
(Street)                                                       (City)                                         (Zip)                           (E-mail)

Telephone: (        )                            Date of Birth:               Marital Status:                      

 

Social Security #:                                                Driver’s License #:                                             
(Out of State Applicants only)                                                                                      (Out of State Applicants only)

 

Employment Information:

Current Occupation:                                                               How Long?                                                         
Business Name:                                                                      Telephone: (       )                 

Address:                                                                                                                                 
(Street)                                                       (City)                                         (Zip)                           (E-mail)

 

Emergency Contact:

Name:                                                                                     Relationship:                                                     
Address:                                                                                                                                 
(Street)                                                       (City)                                         (Zip)                           (E-mail)

Telephone: (        )                                     Work Telephone: (       )                                    

 

Education:

 

Name of School

Dates Attended

Degree/Cert.

High School

 

 

 

College

 

 

 

Other

 

 

 

 

References:  (only one can be a relative)

Name

Address

City, State, Zip

Telephone #

 

 

 

 

 

 

 

 

 

Other:
Do you have any physical conditions that may impact your learning ability or participation in classes? If yes, please explain:

 

 

 

Do you now have, or have you had in the past year any debilitating diseases, i.e., asthma, sciatica?
If yes, please explain:

 

 

 

What is your motivation, intention and purpose for delivering massage?

Why did you choose Body TuneUp School of Massage?

 

 

How did you hear about us?

 

 

Please Attach: (if from out of state)
A copy of your passport, birth certificate or driver’s license with a recent picture on it.

 

Applicant’s Signature:                                                            Date:                                     

                                                                                                                                               

Body TuneUp School of Massage - Personal Instruction at prices you can afford!
1955 Lucile Street, Suite D, Stockton, CA 95209
Call 209-473-4993