CDLC Academy Application
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Email *
Name *
First and Last name
Phone number *
Social Security Number *
Date of Birth *
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Mailing Address *
Emergency Contact Name and Phone *
I understand that I must be at least 18 years of age upon the completion of all courses in the 500-hour program; be physically, mentally, and emotionally capable of completing this program; have a current government issued photo ID and a social security card; to be eligible for application for a Professional Massage Therapy License.  *
Are you a U.S. Citizen? *
Classes *
Required
Education (School Name/ Location/ Year attended)
Diploma/ Major/ Degree
Other Applicable Training
Applicable Skills and Proficiences
Why do you want to become a massage therapist?
What would you like to do after you graduate?
Where do you see yourself in 5 years?
Where do you see yourself in 10 years?
Have you ever had a professional massage?
What do you like most about receiving a massage?
How did you hear about us?
I release and hold harmless, Crème de la Crème Massage Academy, the administrators of, employees, contract laborers, owners and heirs from any liability.
 *
I fully understand that massage therapy is considered a health care service and that certain medical conditions may be intensified, activated, and/or exacerbated by receiving massage and/or hydrotherapy. I realize that I will be receiving massages and hydrotherapy services as part of my training.
 *
A copy of your responses will be emailed to the address you provided.
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