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Cancer Hair Care Pledge Placement Application Form

Professional Hair & Beauty

Foundation in Cancer Treatment Related Hair Loss

Click the button below to start filling out your form

Start

Question 1 of 9

Pronouns (She/her - He/him - They/them - Rather not say - Other: Please specify) - Please type your pronoun in the box below.

 

Question 2 of 9

Business/organisation name - Please type your answer in the box below.

Question 3 of 9

Address

Note: This should be an address that we can send your information and packs to (via post) - Please type your address in the box below.

Question 4 of 9

Profession - Tick all that apply to you:

(Select all that apply)
A

Salon hairdresser

B

Mobile / Home hairdresser

C

Trichologist

D

Dermatologist

E

Wig provider

F

Hair loss specialist

G

Hair replacement provider

H

Hair extensions provider

I

Other please specify in next step

J

Barber

Question 5 of 9

Please specify other profession or put n/a - Please type your answer in the box below.

Question 6 of 9

This course is not intended for people who are currently training for their role. For example a salon junior. With this in mind please let us know how long you have been in your current primary working role. E.g. Hairdressing:

A

2.5 years (minimum requirement)

B

3 - 5 years

C

6 - 9 years

D

10+ years

Question 7 of 9

I wish to apply for a FREE Cancer Hair Care Pledge Placement

 

I understand that the charity Cancer Hair Care Panel will review my pledge and may contact me for further information. 

I pledge to: Please select TWO (or more) of the following 4 options to show your commitment to our charity.

(Select all that apply)
A

Option 1: Volunteer to provide the FREE Cancer Hair Care Hairdressing Ribbon Service

B

Option 2: Hold a Cancer Hair Care Awareness and Fundraising Event

C

Option 3: Shake the coin collector & hold a Wig themed fundraiser

D

Option 4: I want to do it all!

Question 8 of 9

I agree to fulfil my pledge and give my permission to share this information with the Cancer Hair Care & Holistic Hair Care Expert Pledge Panel.

A

Yes - I agree

B

No - I do not agree (form can not be submitted without your agreement)

Question 9 of 9

OTHER INFORMATION: If you have any other comments or information you need to tell us please use this space. For example if you are signing up as a result of a partnership project please tell us what partner e.g. Future Dreams House. - Please type your answer in the box below.

Confirm and Submit