Massage School Application

DOWNTOWN YOGA & HEALING ARTS SCHOOL OF MASSAGE THERAPY
550-HOUR Massage Therapy Program

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Name *

First

Last

Pronouns *

Address *

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City

State

Zip Code

Country

Email *

Date of Birth *

Phone Number *

Do you have a High School diploma, GED, or Homeschool Documentation *

Yes No

List any other Technical, College, Training you have. Include Institution, dates, & degree/certificate *

Do you have any current or recent (within the past three years) physical, mental, or medical conditions that may impact your ability to safely and consistently perform the essential functions of massage therapy training, including but not limited to standing for extended periods, repetitive use of hands and arms, lifting, and giving or receiving bodywork? *

Criminal history: Please note with dates *

Have you ever been convicted of, pled guilty to, or are you currently subject to a court order related to any of the following: harassment, sexual misconduct, stalking, domestic violence, assault, or violation of a protection or restraining order? If Yes, please explain. *

What has inspired you to enter the healing arts field as a massage therapist? *

Tell us a little about yourself! *

Choose the payment option you would most likely be using if you enter the massage program: *

Payment in full DTY Payment Plan

I authorize my credit card to be charged for: *

$50 Non-refundable Application Fee $50 Non-refundable Application Fee & $500 Non-refundable Deposit to hold my spot upon acceptance of application. (Card will not be charged unless accepted into the program.)

CREDIT CARD # *

CODE ON BACK OF CARD *

EXPIRATION *

BILLING ZIPCODE *

Typing your name below indicates that all the information on this application is true and correct to the best of your knowledge. Falsifying information on this application will be considered cause for denial of admission or dismissal from this program without refund of any monies paid. *

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DOWNTOWN YOGA & HEALING ARTS SCHOOL OF MASSAGE THERAPY550-HOUR Massage Therapy Program

DOWNTOWN YOGA & HEALING ARTS SCHOOL OF MASSAGE THERAPY
550-HOUR Massage Therapy Program