Hawaiian Massage School of Kauai

Hawaiian Massage School of Kauai

Registration

Name________________________________________

Address_______________________________________

Email_________________________________________

Phone___________________________________ _____

Cell___________________________________________

Occupation __________________________________

Today’s date____

Age______

Contact person who stays at same address in case you move in the future.

Name_______________________________________________

Phone_______________________________________________

Address_________________________________________

______________________________________________

Email________________________________________________

Please indicate what type of training you are seeking.

_____1 Total Hawaiian Lomi Lmi Massage ( $3900.)

_____2 Spa Therapists Training ($3900)

_____3 Medical Massage and Injury Therapy with

Scoliosis Therapy / Body Balancing ($3900)

_____4 Supplemental Training for out of state therapists (Depends on what is needed)

_____5 Structural Integration Therapy ($4700)

National certification for continuing education hours also available for advanced training. Individual Retreats offered are:

………………Traditional Hawaiian Lomi Lomi Massage……………………………………………………$1500

……………..Hawaiian Hot Sand and Pohaku Stone Therapy………………………..……………$1800

……………..Structural Shoulder Neck and Arm Therapy………………………………………………………..$1500

…………….Scoliosis Therapy with Body Balancing………………………………………………………………………$1200

Please indicate here if you are seeking a payment plan. ________

Please indicate if you are planning to pay for the training by credit card_________

Please indicate if another person other than yourself will be paying your tuition._______

Certified checks, or money orders only, No personal checks accepted.

Make Checks Payable to Hawaiian Massage School of Kauai llc

Send application to

Hawaiian Massage School of Kauai llc

P.O. Box 1065

Hanalei, HI 96714

For application questions please contact us at the School at 808 828-6418

For counseling on options available please ask to speak with Marguerite

Please include a photo of you with your application.

If you would like to do a payment plan I will consider your personal situation and if you

wish you may apply for a payment plan using the fallowing form.

All tuition is due at the time of registration unless the student is doing a payment plan. The payment plan is $700. due at registration. The rest is due in monthly payments for one year at the rate of $280 per month and must be completed before graduation.

Student financing and scholarships’ are available upon request and meeting of certain criteria.

Place Photo here

Credit Card Application

I would like to pay by Credit Card

Visa MasterCard American Express

#__________________________________________________

Exp. Date___________________________

Amount to charge to card_______________________________

Name as it appears on

card______________________________________________

Cardholder

signature_____________________________________________

Billing address of card used

___________________________________________________________________________________________________________________________________________

Application for Payment Plan

Name________________________________________

Address_______________________________________

Email_________________________________________

Phone___________________________________ _____

Cell___________________________________________

Occupation __________________________________Today’s

date____

Do you have a relative or friend willing to co-sign the loan application for

you.________

Name and address of co-signer if applicable

Name_______________________________________________

Phone_______________________________________________

Address_____________________________________________

Email________________________________________________

Reasons you need a payment plan to pay for your

tuition_______________________________________________

____________________________________________________

Employer Name_______________________________________

Employers Phone______________________________________

Please state your plan to repay this

loan_________________________________________________

____________________________________________________

Print Name ________________________________Date____

Sign Name ________________________________Date______

Co barrower’s signature__________________________Date______

Consent Agreement

Please sign below if you give your consent to have a photo or video from the class you

attend with you in it on my web site or other publication..

Signature______________________________

I look forward to working with you and ask that you contact me with any questions and let’s talk about it. I want you to have a wonderful learning experience, so let me know any way I can accommodate

you. Please sign below indicating you have read the information contained in this form and are willing to

attend the training under these conditions.

Print Name_____________________________________________

Cancellation and Refund Policies

Full refund of tuition and fees

The student will receive a full refund of tuition and fees if:

1. The student requests cancellation within 5 calendar days after signing the Enrollment

Agreement if no classes have been attended, lessons completed or materials used. The

applicant within an additional period of 5 calendar days must confirm this request, in

writing. After 5 calendar days or after 10 calendar days absent without written

confirmation, the school will retain the Registration Fee; or

2. The applicant is not accepted for admission by the school; or

3. The school cancels the program prior to the applicant beginning class.

For Programs:

Partial Refund

Students will be eligible for a partial refund:

1. If a student cancels after the fifth calendar day following the date of enrollment, but

prior to the scheduled beginning of training, tuition paid to the school shall be refunded.

The school shall retain the registration fee.

2. If a student enrolls and withdraws or discontinues after the scheduled program has

begun, but prior to the enrollment period graduation date, the following refund policies

apply'.

A. If termination occurs during the first 7 calendar days of the enrollment period,

this will result in the school retaining the Registration Fee and 25% of the

tuition charge.

B. If termination occurs after the first 7 calendar days of the enrollment period, but

within the first 25% enrollment period, this will result in the school retaining the

Registration Fee and 45% of the tuition charge.

C. If termination occurs after 25% of the enrollment period, but within 50%

(calendar midpoint) of the enrollment period, this will result in the school retaining

the Registration Fee and 70% of the tuition charge. Termination due to

catastrophic illness or injury will result in a pro-rata refund.

No Refund

If termination occurs after 50% (calendar midpoint) of the enrollment period, this will result

in the school retaining the Registration Fee and 100% of the tuition charge.

Refund Payments

All refunds due will be made to the original funding source(s) within 30 business days of

the determined withdrawal, cancellation or termination date from the course or program.

I agree to enroll in the Hawaiian Massage School of Kauai under the understanding

that I have read and agree to the refund policies of the school.

Print Name_______________________________________

Sign _________________________________________Date______