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CDLC Academy Application
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Email
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Your email
Name
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First and Last name
Your answer
Phone number
*
Your answer
Social Security Number
*
Your answer
Date of Birth
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DD
/
YYYY
Mailing Address
*
Your answer
Emergency Contact Name and Phone
*
Your answer
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.
*
Yes
No
Other:
Are you a U.S. Citizen?
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No
Classes
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Day
Night
Weekend
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Education (School Name/ Location/ Year attended)
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Diploma/ Major/ Degree
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Other Applicable Training
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Applicable Skills and Proficiences
Your answer
Why do you want to become a massage therapist?
Your answer
What would you like to do after you graduate?
Your answer
Where do you see yourself in 5 years?
Your answer
Where do you see yourself in 10 years?
Your answer
Have you ever had a professional massage?
Your answer
What do you like most about receiving a massage?
Your answer
How did you hear about us?
Your answer
I release and hold harmless, Crème de la Crème Massage Academy, the administrators of, employees, contract laborers, owners and heirs from any liability.
*
Agree
Disagree
Other:
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.
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Other:
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