Spring Renewal Professional Massage Training Program

3493 Blue Star Hwy. Saugatuck, MI 49453

Phone: (616) 857-2602 Fax: (616) 857-2402

www.springrenewal.com E-mail: peace@springrenewal.com

Student Application/Enrollment Form

Name:______________________________________________________________________________

Address:____________________________________________________________________________

City, State, ZIP:_______________________________________________________________________

Home Phone: _______________________________ Work Phone: ______________________________

e-mail:______________________________________________________________________________

Social Security Number:________________________________________________________________

Emergency Contact Name and Phone:_________________________________

Education: High School Diploma GED or Equivalent College--Name, Years attended, Course of study, Degree:________________________________________________________________________

Current Employment: Company Name, Address, Phone, Position Held: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

Have you ever been convicted of a felony or misdemeanor other than traffic violations ____________

If yes, please explain: __________________________________________________________________ ___________________________________________________________________________________

Previous Massage Training or Experience:__________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

Do you have any medical condition or physical limitation that requires special assistance? ___________

If yes, please explain:__________________________________________________________________ __________________________________________________________________________________

Program Selection:

600 Hour Professional Massage Training Program

Enrichment Course: _________________________________________________________

If enrolling for the 600 hour program, on the back of this form, please share your background, motivation, and goals as they relate to your decision to study professional massage therapy at Spring Renewal.

Refund Policy

All tuition and fees paid by the applicant shall be refunded if the applicant is rejected by the school before enrollment. An application fee of not more than $25.00 may be retained by the school if the application is denied. All tuition and fees paid by the applicant shall be refunded if the application is denied. All tuition and fees paid by the applicant shall be refunded if requested within three business days after signing a contract with the school. All refunds shall returned within 30 days. Once the three business days have elapsed, the following policy will apply:

Student may withdraw from a Module during the first two weeks without receiving an incomplete. If withdrawal is requested before the second day of the Module, the student will not be charged for that Module. No refunds will be made after that.

If a student wishes to terminate from the PMTP, a refund will be given for Modules not taken, minus a fee of $200. There is not refund of tuition is the student is expelled or administratively dropped from the program.

I certify that all information given is true and correct.

Signature: _________________________________ Date:____________

Interviewer: ________________________________ Date:____________

Please include $100 application fee, if applying for the 600 hour program. No application fee is required for enrichment classes.

Accepted _____ Not Accepted _____ Reason:________________________

Financial Arrangements: Cash ______ Payment Plan ______ CC ______