Mirage Spa Education

Secure Enrollment

SECURE ENROLLMENT FORM

Complete the secure enrollment form below. All fields marked with * are required.

Student Information

Are you a returning student to Mirage Spa Education? Please answer YES or NO. If YES, what name were you registered under and what date did you complete your course? *

We now offer low interest payments. Please use this link to see if you qualify. This is a soft credit check and will not affect your credit score. https://apply.medicard.com/24065 *

What course are you registering for? All supplies including textbook and shipping costs are included in the ENROLLMENT fees listed below. Please allow for taxes in your province. There are no taxes added for shipping outside of Canada. *

Hold Ctrl (Windows) or Cmd (Mac) to select multiple courses.

Social Insurance Number (As a designated learning institution we are required by the Private Training Institute of British Columbia, PTIB, to collect this information.) *

Personal Details

First Name *

Last Name *

Address

Complete Street Address *

City *

State/Province *

Postal / Zip Code *

Country *

Contact & Enrollment

Mobile Phone Number *

What is your date of birth *

Do you give permission to receive text messages from Mirage or any affiliates associated with Mirage for the purpose of enrolment? *

Email Address *

Preferred Start Date *

Your start date will be set after full tuition is received. This is typically within 48 hours but may take up to 3 weeks. If you are applying for funding, please select a start date at least 6 weeks from your application date to your funder.

Please indicate how you will fund your tuition. *

If self funded, when and how will you send payment in full. (E-transfer and credit card payments accepted.)

Name and mobile number (Emergency Contact Number)

Do you identify yourself as an Aboriginal person, that is First Nations, Metis or Inuit?

Do you have a long-term physical or mental health condition that limits the kind of activity that you perform daily?

Documents

Please provide a copy of your valid I.D. *

Upload 1 supported file. Max 10 MB.

Please upload a copy of your diploma or completion certificate here.

Upload 1 supported file. Max 10 MB.

Please upload your Esthetics certificate or diploma here.

Upload 1 supported file. Max 10 MB.

If you do not have an Esthetics certificate or diploma, what work experience do you have? Please include name and phone number of supervisor.

Complete the secure enrollment form below. All fields marked with * are required.

Student Information

Personal Details

Address

Contact & Enrollment

Documents

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Secure Enrollment

Complete the secure enrollment form below. All fields marked with * are required.

Student Information

Personal Details

Address

Contact & Enrollment

Documents

About Mirage

Get in Touch

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Your cart