New Appointment Form

Because Every Teen Deserves a Moment To Shine

Name*

Preferred Name/Nickname

Date of Birth*

Age*

School Name/ Grade Level *

Email*

Phone Number

Preferred Method of Contact*

Txt

Email

Phone Call

What Are You Celebrating*

Prom

Graduation

Homecoming

Award Ceremony

Other

Event Date*

Do You Already Have Part of Your Outfit?*

Your Style/Mood*

Classic

Trendy

Glamorous

Minimalist

Surprise Me!

Favorite Color*

Outfit Type You're Looking For*

Dress

Suit

Jumpsuit

Open To Anything!

Shoe Size*

Clothing Size (approximate)*

Any Accessibility Needs or Special Requests?*

Okay to Be Featured in Photos or Social Media?*

Yes, I’m cool with it

No, I prefer privacy

How Did You Hear About Us?*

School

Friend

Social Media

Community Center

Other

By submitting this for I understand that all services and items provided are free of charge and meant to support teens attending milestone events with dignity and joy. Do you agree? *

Connect

Empowering teens with quality formal wear

Support

Contact

glimmerstone

+12345678901

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