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Please fill out the form to register for this class.
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First Name
Last Name
Mailing Address
City
State
Zipcode
Email Address
Contact Phone #
Drivers License or State ID #
Are you a Makana Academy Alumni?YesNo
If yes, date and year graduated?
Hawaii Esthetician License
Current Employment Information
Name of Business
GE Tax Number
Years in Business
Business Address
Do you have any health problems we should be aware of?YesNo
If yes, please explain:
Are you currently under a physician’s care? YesNo
Are you taking any prescription or over-the-counter medication we should be aware of? YesNo
Will you have any special needs or requirements while attending Makana Academy? YesNo
Do you have any allergies or medical conditions which may prevent you from receiving and/or giving hands-on treatments during the practical portion of this program?YesNo
Do you have any condition (i.e. physical, emotional or otherwise) that we should be aware of and/or may prevent you from full participation in your program at Makana Academy?YesNo
Prospective students should be aware that full participation in esthetic treatments, both giving and receiving, is a requirement for satisfactory progress and program completion at Makana Academy. Prospective students must understand that without a physician’s certification, failure to participate fully in clinical treatments and practical experience, will adversely affect your grades. This may even affect your ability to complete the program and graduate from Makana Academy. Any condition that may prevent full participation must be fully disclosed prior to your enrollment. Makana Academy must be given the opportunity to accommodate you during your program. Please attach a physician’s certification describing your condition and how it would affect your ability to fully participate.
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