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Name____________________________________________________________
Home #_________________ Cell #__________________
Address_________________________________ City________________
State____ Zip________
E-mail Address________________________________ Birthdate________________________
Emergency Contact _______________________________ Phone_______________________
Do you have a High School Diploma or GED? _______________________________________
Are you presently employed? ___________ If yes, please answer the following questions:
Company Name_____________________________ Position___________________________
Address__________________________________________Phone______________________
How did you hear about us? _____________________________________________________
Have you had any previous massage classes or formal training?_________________________
____________________________________ ________________________ _______________
What sparked your interest in massage & what are your goals for school?
____________________________________________________________________________
____________________________________________________________________________
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Anything else we should know? Tell us a little about yourself.
____________________________________________________________________________
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References: Name Phone Relationship
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Enrollment Agreement
Student Information
Student Name: ________________________________________________________________________
Address: _____________________________________________________________________________
City: ________________________ State: _______________ Zip: ____________________
Home Phone Number: ______________________ Cell Phone Number: __________________________
Email Address: ____________________________________________________
Birthdate: __________________________________ Social Security Number: _____________________
Emergency Contact: ____________________________________________________________________
Relationship: ___________________________________ Phone Number: _________________________
Do you have a High School Diploma of GED? _________________________________________________
Are you Employed? __________ If yes, please answer the following questions:
Company Name: _______________________________ Position: _______________________________
Address: __________________________________________ Phone :____________________________
How did you hear about us? ______________________________________________________________
Have you had any previous massage classes or formal training? _________________________________
What sparked your interest in massage and what are your goals for school?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Anything else we should know? Tell us a little about yourself
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
References:
Name: ____________________________________ Phone:_________________________
Relationship: _______________________________
Name: ____________________________________ Phone:_________________________
Relationship: _______________________________
Name: ____________________________________ Phone:_________________________
Relationship: _______________________________
Program Information
Date of Admission: __________________________
Program Name: ________________________________________________________________________
Program Start Date: _______________________ Scheduled End Date: __________________________
Time Class Begins: ________________________ Time Class Ends: ______________________________
Number of Weeks: _______________________ Total Credit Hours: _____________________________
Financial Aid
The Healing Tree Massage School has outsourced to outside financial intuitions.
Entrance Requirement
The Healing Tree Massage School does not discriminate based on race, sex, religion, ethnic origin, or disability. We require a High School Diploma or GED and a desire to help people.
Enrollment Procedures
Prospective students may enroll anytime. Late enrollments will be accepted only one week into the course, depending on length of course. After filling out the application we will set up a time to meet with you to discuss our program and what we have to offer.
Transferability of Credits and Credentials Earned at Our Institution
The transferability of credits you earn at The Healing Tree Massage School is at the complete discretion of an institution to which you may seek to transfer. Acceptance of the certificate you earn in the educational program is also at the complete discretion of the institution to which you may seek to transfer. If the certificates that you earn at this institution are not accepted at the institution to which you seek to transfer, you may be required to repeat some or all of your coursework at that institution. For this reason you should make certain that your attendance at this institution will meet your educational goals. This may include contacting an institution to which you may seek to transfer after attending The Healing Tree Massage School to determine if your certificate will transfer.
Recognition of Credits Transferred from Other Institutions
The Healing Tree Massage School will recognize credit hours where the curriculum is substantially similar in scope and content to that of the program the student wishes to transfer into. This will be at the discretion of the Faculty and Administration and it must be a unanimous decision. Each student’s situation will be evaluated on a person to person basis.
Grading System
90 – 100 = A Excellent
80 – 89 = B Above Average
70 – 79 = C Average
60 – 69 = D Below Average
Under 60 = U Unsatisfactory
Attendance Policy
Students are expected to arrive on time for class with proper materials. An overall attendance rate of at least 85% is required. Instructors may request your withdrawal from a course or program if absences or tardiness exceed 70%. Students who are unable to continue classes for medical reasons or severe personal problems will be required to take a leave of absence until they are able to return to class. Proper documentation will be required to substantiate a student’s withdrawal.
Rules of Conduct
Weapons, Tobacco, Alcohol and Drugs: The Healing Tree Massage School has a zero tolerance policy with regard to weapons, illegal drugs, tobacco, and alcohol of any kind are not allowed at any time on school property. Use of tobacco products, including smokeless tobacco and nicotine vaporizers are prohibited on school grounds. Likewise, alcohol, illegal drugs and/or being under the influence of said substances is strictly prohibited in school grounds. Any violation of school policies may result in permanent dismissal from school.
Dress Code: Students are expected to dress comfortably in flexible clothing. Sweat pants or yoga pants and the school t-shirt are recommended. Sleeveless shirts, tank tops, low scooping V necks, are inappropriate. T-shirts should have at least a ¼ length sleeve and cover the midriff completely. Clean socks, bare feet, or indoor-only shoes are required. Nails should be trimmed short and long hair should be tied back. Students are asked to avoid strongly scented products such as perfumes, colognes, body sprays, deodorants and essential oils. A student arriving to class with inappropriate clothing, poor hygiene or strong scents may be asked to rectify the issue or not attend that class.
Hygiene: Students are expected to arrive to class in as fresh a state of bodily cleanliness as possible. Please be considerate of the fact that others will be touching you and may not want to handle sweaty, dirty or odiferous persons. Fresh breath is also highly appreciated therefore good dental hygiene is encouraged. Students are expected to wash their hands before a massage, after a massage, after using the restroom and after eating. Any items that come into contact with bare skin should be washed after massage work including sheets, pillow cases, towels and oil or lotion bottles. Students who arrive to class with poor hygiene may be asked to leave at the instructors’ discretion.
Classroom Conduct: Students shall behave in an appropriate manner for the classroom environment and in regards to the nature of the work at hand.
 Cell phone and smart phone use is prohibited in the classroom. Phone calls and texts should be made during breaks and outside the school.
 Do not interrupt or talk over an instructor or fellow student.
 Please raise your hand and wait to be addressed to ask a question to make a comment.
 No eating in the classroom.
 Please observe the scheduled breaks; do not leave the classroom mid-lecture or demonstration if at all possible, emergency restroom breaks aside.
 No sleeping during class.
The Massage Therapy Profession
The Healing Tree Massage School will prepare you for the massage therapy profession as well as the test you need to get licensed. Our program will include 850 combined class, in class massage, and clinical massage hours. School will start January 22, 2018 and will go through September 30, 2018. Placement assistance is offered to our students. We have connections with local Chiropractors as well as spas and resorts in the area. We cannot guarantee placement or wage salary levels.
Massage Therapists are in high demand, have the benefit of flexible hours, independence, and can work in a variety of settings, such as:
 Massage Office
 Cruise Ships
 Spas and Resorts
 Sports Teams and Events
 Chiropractic offices
 Physician’s offices
 Hospitals and Wellness Centers
 Nursing Homes
For more information on Massage Therapy please visit www.amtamassage.org
Tuition & Fees
1st Semester
Non-Refundable Registration Fee: $ 100.00
Tuition: $ 3,750.00
Books (approximate): $ 250.00
Lotions/Oils/Creams: $ 75.00
Sheets (4 sets): $ 60.00
2nd Semester
Tuition: $ 3,750.00
Books (approximate): $ 250.00
Mblex Licensure Exam Fee: $ 195.00
Utah Massage License Fee: $ 100.00
Total Cost for Program: $ 8,530.00
Refund/Cancellation Policy
For applicants who cancel enrollment or students who withdraw from enrollment a fair and equitable settlement will apply. The following policy will apply to all terminations for any reason, by either party, including student decision, course or program cancellation or school closure.
Any monies, except the non-refundable registration fee, due the applicant or students shall be refunded within 90 days of official cancellation or withdrawal. Official cancellation or withdrawal shall occur on the earlier of the dates that:
1. An applicant is not accepted by the school. The applicant shall be entitled to a refund of all monies paid.
2. A student (or legal guardian) cancels his/her enrollment in writing within three business days of signing the enrollment agreement. The three-business-day cooling-off period, commencing with the day an enrollment agreement with the applicant is signed or an initial deposit or payment toward tuition and fees of the institution is made, until midnight of the third business day following such date or from the date that the student first visits the institution, whichever is later, shall be applicable and during this time the contract may be rescinded by the student and all money paid refunded.
3. A student cancels his/her enrollment after three business days of signing the contract but prior to submission by the student of any lesson materials or prior to receipt of course materials, whichever comes first, and effective upon deposit of a written statement of withdrawal for delivery by mail or other means, and the institution shall be entitled to retain the $100 registration fee.
4. A student notifies the institution of his/her withdrawal in writing.
5. A student on an approved leave of absence notifies the school that he/she will not be returning. The date of withdrawal shall be earlier of the date of expiration of the leave of absence or the date the student notifies the institution that the student will not be returning.
6. A student is expelled by the school. (Unofficial withdrawals will be determined by the institution by monitoring attendance at least every 30 days.)
7. In item 2,3,4 or 5, official cancellations or withdrawals, the cancellation date will be determined by the postmark on the written notification, or the date said notification is delivered to the school administrator or owner in person.
For students who enroll and begin classes but withdraw prior to course completion (after three business days of signing the contract), the following schedule of tuition earned by the school applies. All refunds are based on scheduled hours:
Percent of Scheduled Time Total Tuition School Shall Enrolled to Total Course/Program Receive/Retain
0.01% to 4.9% 20%
5% to 9.9% 30%
10% to 14.9% 40%
15% to 24.9% 45%
25% to 49.9% 70%
50% and over 100%
All refunds will be calculated based on the students last date of attendance. Any monies, except the registration fee, due a student who withdraws shall be refunded within 90 days of a determination that a student has withdrawn, whether officially or unofficially. In case of disabling illness or injury, death in the student’s immediate family or other documented mitigating circumstances, a reasonable and fair refund settlement will be made. If permanently closed or no longer offering instruction after a student has enrolled, the school will provide a pro rata refund of tuition to the student OR provide course completion through a pre-arranged teach out agreement with another institution. If the course is cancelled after students have enrolled and instruction has begun, the school shall provide a pro rata refund for all students transferring to another school based on the hours accepted by the receiving school OR provide completion of the course OR participate in a Teach-Out Agreement OR provide a full refund of all monies paid.
Students who withdraw or terminate prior to course completion are charged a cancellation or administrative fee of $150. This refund policy applies to tuition and fees charged in the enrollment agreement. Other miscellaneous charges the student may have incurred at the institution (EG: extra kit materials, books, products, unreturned school property, etc.) will be calculated separately at the time of the withdrawal. All fees are identified in the catalog and in this enrollment agreement. Notice To Student
1. Do not sign this agreement before you have read it or if it contains any blank spaces.
2. This agreement is a legally binding instrument and is only binding when the agreement is accepted, signed, and dated by the authorized official of the school or the admissions officer at the school’s principle place of business. Read all pages of this contract before signing.
3. You are entitled to an exact copy of the agreement and any disclosure pages you sign.
4. This agreement and the school catalog constitute the entire agreement between the student and the school.
5. Any changes in this agreement must be made in writing and shall not be binding on either the student or the school unless changes have been approved in writing by the authorized official of the school and by the student or the student’s parent or legal guardian. All terms and conditions of the agreement are not subject to amendment or modification by oral agreement.
6. The school does not guarantee the transferability of credits to another school, college, or university. Credits or coursework are not likely to transfer; any decision on the comparability, appropriateness and applicability of credit and whether credit should be accepted is the decision of the receiving institution.
7. Registered under the Utah Postsecondary Proprietary School Act (Title 13, Chapter 34, Utah code). 8. Registration under the Utah Postsecondary Proprietary School Act does not mean that the State of Utah supervises, recommends, nor accredits the intuition. It is the student’s responsibility to determine whether credits, degrees, or certificates from the institution will transfer to other institutions or meet employers’ training requirements. This may be done by calling the prospective school or employer.
9. The intuition is not accredited by a regional or national accrediting agency recognized by the United States Department of Education.
Student’s Right to Cancel
The student has the right to cancel the initial enrollment agreement until 7 days, unless school has school has started, after the student has been admitted. If the right to cancel is not given to any prospective student at the time the agreement is signed, then the student has the right to cancel the agreement at any time and receive a refund in all monies paid within one week of cancellation. Cancellation should be submitted to the authorized official of the school in writing. Student Acknowledgments
1. I hereby acknowledge receipt of the school’s catalog, which contains information describing programs offered, and equipment or supplies provided. The school catalog is included as part of this enrollment agreement and I acknowledge that I have received a copy of this catalog.
Student Initials ____________
2. I have carefully read and received an exact copy of this enrollment agreement.
Student Initials ____________
3. I understand that the school may terminate my enrollment if I fail to comply with attendance, academic, and financial requirements or if I fail to abide by established standards of conduct, as outlined in the school catalog. While enrolled in the school, I understand that I maintain satisfactory academic progress as described in the school catalog and that my financial obligation to the school must be paid in full before a certificate may be awarded.
Student Initials ____________
4. I hereby acknowledge that the school has made available to me all required disclosure information listed under the Consumer Information section of this Enrollment Agreement.
Student Initials ____________
5. I understand that the school does not guarantee transferability of credit and that in most cases, credits or coursework are not likely to transfer to another institution. In cases where transferability is guaranteed, the school must provide us with copies of transfer agreements that name the exact institution and include agreement details and limitations.
Student Initials ____________
6. I understand that the school does not guarantee job placement to graduates upon program completion.
Student Initials ____________
7. I understand that complaints, which cannot be resolved by direct negotiations with the school in accordance to its written grievance policy, may be filed with the Utah Division of Consumer Protection, 160 E 300 S, Salt Lake City, UT 84111 or dcp.utah.gov
Student Initials ____________
The Student acknowledges receiving a copy of this completed agreement, the school catalog, and written confirmation of acceptance prior to signing this contract. The student by signing this contract acknowledges that he/she has read this contract, understands the terms and conditions, and agrees to the conditions outlined in this contract. It is further understood that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreements and may not be modified without the written agreement of the student and the School Official. The student and the school will retain a copy of this agreement.
I the undersigned, have read, understand and agree to abide by all the provisions set forth in the foregoing enrollment agreement.

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Student’s Signature Date


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Program Director’s Signature Date