Back-to-School Teen Skincare Masterclass

Participant Intake Form | Memorial Villages Residency | August 8th–9th

For beginners, ages 12–18. Please complete one form per participant. Fields marked with an asterisk (*) are required.

Participant Information

First Name

Last Name

Age

Date of birth

School / Grade Entering This Fall

Which class are you attending? * (please check one)

Tween Class- Saturday, 8th, August @ 12.00PM

Tween Class- Sunday, 9th, August @12.00PM

Parent / Guardian Information

Parent / Guardian Full Name * *

Relationship to Participant *

Email *

Phone *

Emergency Contact Name (if different from above)

Emergency Contact Phone

Skin Profile

Current Skin Concerns (check all that apply):

Texture

Hyperpigmentation

Fine Lines & Wrinkles

Loss of Firmness

Acne & Breakouts

Dehydration

Uneven skin tone

Sensitivity & Redness

Skin Type (check all that apply):

Normal

Dry

Oily

Combination

Sensitive

Not Sure

Skincare products currently used (cleanser, moisturizer, SPF, etc.)

Medical & Allergy Information

Known allergies or sensitivities to skincare ingredients

Diagnosed skin conditions

Currently using prescription skincare or acne medication?

Yes

No

If yes, please list:

Medical & Allergy Information

This masterclass is an educational skincare workshop and does not constitute medical advice, diagnosis, or treatment. Products used are gentle, age-appropriate, and intended for topical demonstration purposes only. By signing below, I confirm the information provided above is accurate and give permission for my child to participate in all class activities, including guided use of sample skincare products.

I give permission for my child to participate in the masterclass.

I consent to photos/videos from the class being used for promotional purposes (optional).

Sign Here

Clear

Privacy Policy | Terms of Service