Napa Valley School of Massage

Legal Name of Applicant (Last, First, Middle):_________________________________________________________________

Social Security #: _________-_________-____________ Date of Birth (Month, Day, Year): ________/________/________

Telephone Number: Home (__________) __________-____________ Work (__________) __________-__________

Email Address: ___________________________________________________________________

Mailing Address: Street _______________________________________________________________________
(if different from above)

City _____________________________________ State _________ Zip ____________________

How did you learn about the Napa Valley School of Massage? ____________________________________________________________

Please list your previous education/training: _________________________________________________________________________

__________________________________________________________________________________________________________

Napa Valley School of Massage

Enrollment Agreement for Basic 250 hour Course By Distance Learning

Student Name: ___________________________________ Social Security Number: _____-_____-_____

Course Title: “Restorative Massage Therapy” Total hours of course work to be completed: 250 hours ONLINE –DISTANCE LEARNING FORMAT

Course Description: a comprehensive course with an emphasis on Eastern & Western massage techniques with overview of anatomy, physiology & special attention on professional ethics; incorporated with practical application on patients.

Student's Start Date: ____/____/____ Scheduled Completion Date: ____/____/____

Upon successful completion of the above course, you will receive a Certificate of Completion.

Fees:
Registration Fee:	$300.00	The Napa Valley School of Massage will retain the $300.00 registration fee should the student withdraw from the course and cancel the Enrollment Agreement.

Tuition:	$2,000.00	Prorated upon course withdrawal. Refer to the refund table. If a student should submit the Notice of Cancellation after 50 hours, he/she would receive a tuition refund of 25% (50 hours completed/250 hours of tuition paid).
TOTAL CHARGES:	$2,300.00*	All amounts paid for instruction, supplies & required uniform. Does not include text book estimated at $20.00. * You are responsible for this amount.

* This Contract is a legally binding instrument when signed by the student and accepted by the school.

* BUYER'S RIGHT TO CANCEL - the student has the right to cancel the enrollment agreement and obtain a

refund. The student must complete the written “Cancellation Notice” form and submit it to the Associate

Director. The refund is prorated after the second week of access to the online course.

Tuition refunds are given to students according to the SAMPLE REFUND TABLE. To be eligible for a refund, the student must fill out, sign and date a notice of cancellation. The following is a summary of the refund table. A 100% tuition refund will be given to a student any time before the fifth business day following the date of enrollment. A partial tuition refund will be given to a student on a pro rata basis according to the refund table. No refund will be given after 60% of the class has been completed. Please review the refund table carefully. If you have no questions, sign the statement at the bottom that says: “I have read and understand the refund table.” If you as an enrolling student in the Napa Valley School of Massage are not a California resident, you will not be eligible for protection or financial recovery from the student tuition recovery fund.

__________________________________________ “I have read and understand the refund table.”

^{Signature of Student}

__________________________________________ Initial that copy was given to the student _____

^{Signature of Associate Director}

If you have any complaints, questions or problems which you cannot work out with the school, write or call:

Bureau for Private Postsecondary and Vocational Education,

P.O. Box 980818, West Sacramento, CA 95798-0818, (916) 445-3427

1. You may cancel your enrollment at the Napa Valley School of Massage at any time (please review Cancellation Notice Form). Registration Fees for courses are NON- REFUNDABLE. You may cancel your enrollment at any time in the first ten days without being charged tuition (you will forfeit the Registration Fee). Should you cancel your enrollment after the first ten days, you will be charged tuition for the course work completed based on the Refund Table. Students taking the Online Course will be charged based on a percent of the 27 lessons completed.

2. If the school closes before you graduate, you may be entitled to a refund. Contact the Bureau for Private Postsecondary and Vocational Education at the address and telephone number printed below for information.

Bureau for Private Postsecondary and Vocational Education
P.O. Box 980818, West Sacramento, CA 95798-0818
(916) 445-3427

3. If you have any complaints, questions or problems which you cannot work out with the school, write or call:

Bureau for Private Postsecondary and Vocational Education
P.O. Box 980818, West Sacramento, CA 95798-0818
(916) 445-3427

I have read and understand my rights as a student at the Napa Valley School of Massage.

Student’s Signature _______________________________________________ Date ________/________/________

Signature of School Representative _______________________________________________ Date ________/________/________

5. Use of alcohol or before or during class is prohibited and is reason for dismissal.

11. Be on time for class. Leaving class early without prior arrangements is not permitted.

12. Attendance is mandatory. Two tardies will be considered an absence. Three absences warrant academic counseling. A total of six absences is a reason for dismissal.

13. Online assignments are mandatory. Students will not be permitted to move on to new lessons without completing all previous online assignments.

I have read and understand the rules and regulations for the Napa Valley School of Massage.

Student’s Signature _______________________________________________ Date________/________/________

1. Never discuss patients with others. This includes unnecessary conversation within the clinic and all conversations outside the clinic. All patient information is strictly confidential.

4. Sexually oriented jokes and conversations are strictly prohibited. The therapist should terminate the massage and notify the clinic Director immediately.

5. Never touch a patient's breasts or genital area. Massage of the buttocks should only be undertaken with the patient's prior permission. Massaging the buttocks through clothing or a clean towel will provide the patient with more privacy and comfort.

6. Should you ever feel uncomfortable during the treatment, you should terminate the massage and immediately report the incident to the clinic Director.

7. Never diagnose patient's illnesses or try to treat medically. In the clinic, you are working under the direct supervision of a physician.

8. Should you notice or become aware of a potential health problem, you should recommend that the patient mention this to their physician. State simply "I recommend you show this to your doctor". Do not elaborate, never offer advice or recommend medication.

11. Clinic patients at the Heart & Health Center have a doctor - patient relationship with Dr. Andrews. They may only receive massage treatments in the clinic under Dr. Andrews' supervision. Students and faculty are not permitted to treat these patients outside the clinic or without Dr. Andrews' order.

12. Follow up appointments and questions about billing will be handled by the clinic staff. Notify the Director about any problems.

15. Always be respectful of the patient's privacy. Keep their body covered except for the area you are working on.

17. Be polite and say "your welcome" when a patient thanks you for your treatment.

18. Make detailed massage therapy chart notes at the conclusion of the treatment.

Sample Calculation for Refund		Refund Policy A refund will be given to a student who completes the Notice of Cancellation. This refund is based on the following: A 100% refund will be given up to ten days following enrollment. The Registration Fee is NON-REFUNDABLE. The student’s tuition refund is pro rata after ten days following enrollment. After the student has completed 60% of the course, no refund will be issued.

Date of Enrollment
Hours Completed by Student
Hours of Course total
Percent of Course Completed
Tuition Paid to Date
% Course Completed X Tuition Paid
Refund to Student

Student’s Signature _______________________________________________ Date ________/________/________

Payment Agreement

The policy of the Napa Valley School of Massage is for all students to pay their tuition upon enrollment. On occasion, the NVSM will agree (on an individual basis) to allow students to make payments. These payments must be made based on the below schedule. Failure to make tuition payments in a timely fashion will result in termination of this agreement and interruption of the student’s studies.

The student agrees to pay $300.00 for the non-refundable uniform and registration fee today to reserve his or her space in the class.

in______(number of equal payments). Note: All payments must be of equal amount and in no more than four payments (including the initial payment).

The last and final payment is due before the last day of class and before the final exam.

I have read and understand this payment agreement. I understand that I will not be granted a Diploma from the Napa Valley School of Massage until my tuition is paid in full. I also understand that I may be dismissed from the Napa Valley School of Massage for failure to pay tuition.

^{Signature of Student _________________________________________ Signature
of Associate Director _________________________________________}

^{Date _________________________________________
Date_________________________________________}

Registration Fee	$300.00	The Registration Fee is NON-REFUNDABLE.
Tuition	$_____	The Tuition will be refunded at 100% within the first ten days following enrollment date. After this date, the student will be charged a percent of tuition based on the course work completed.