Synergy Institute

Email Address*

First Name*

Last Name*

Phone Number*

Address*

City*

Zip Code*

State*

Date of Birth*

Social Security*

Emergency Contact*

Emergency Contact Phone*

Do you prefer day class or evening class ? *

Preferred scrub top and bottom size ? *

Are you a veteran ? *

I hereby enroll and obligate myself to pay to the order of Synergy Massage Institute the amounts indicated for registration, tuition, and book & classroom fee for the 500 hour Massage Therapy program. I certify that I have read both sides of the Enrollment Contract in its
entirety; I agree to the financial terms that I have chosen and accept the stated enrollment agreement and refund policies as written.

Electronic Signature*

Clear

Date*

Financial Information

The tuition of $7,500 is due before the first course of the 500 hour Massage Therapy program. This fee includes all classroom and practical instruction. There will be an additional $250 in book fees.
*Tuition excludes licensing fees

Refund Policy

For a student who withdraws after the signing of this commitment letter and payment is received, the following conditions will apply:

-During the first two weeks of class, 85% of tuition amount will be refunded
-After the first two weeks, but in the first 25% of the semester, 60% of tuition will be refunded
-During the second 25% of the semester, 50% of tuition will be refunded
-There will be no refunds given during the second half of the semester

I understand the tuition payment agreement I have chosen on the reverse side of this contract. Should I
default on this agreement, I agree to be responsible for all legal fees incurred in the collection process.
I have received a school catalog with a class schedule, an outline of courses and their descriptions, refund policy, job placement assistance, and other miscellaneous information regarding the course.
I agree to comply with school policies during my term of enrollment.
I understand that enrolling in massage therapy training is physically, psychologically, and emotionally demanding and verify that I am in good health and have no concerns that may interfere with said training.
Additionally, I agree to hold harmless Synergy Massage Institute for any development of new health problems or exacerbation of pre-existing health problems that occur during my said training program (Initials )
I understand that video and still photography may be used in promotional and instructional materials.
I understand that a portion of class resources may only be available online, and that I will need off-site access to a personal computer with internet access.. I understand that I am also required to have an email address that I check regularly.
I further understand that I will be required to give and receive massages and agree to participate during class and during student clinic in order to graduate.

Application/
Enrollment

Financial Information

Refund Policy

For more information call Erin 985-290-7873 or email synergymassageinstitute@gmail.com

Application/ Enrollment

Financial Information

Refund Policy

For more information call Erin 985-290-7873 or email synergymassageinstitute@gmail.com

Application/
Enrollment