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Registration, Deposit, and Order Form
Today’s Date: ___________
Weekend Course Date: ___________________________
Hours: Friday 2-8pm; Saturday & Sunday 10am-6pm
First and Last Name:
Address:
City, State, Zip:
Mobile Telephone:
Email:
Massage license #
Item (circle appropriate items) – our curriculum is 250 hours!
Thai Massage Fundamentals
LPK – Traditional Thai Herbal Compress Massage
Table Thai – Table Fundamentals (Sat/Sun only)
HandsFree Fundamentals or Advanced
LPK – Thai Herbal Steamed Compress Massage for SPA
Therapeutic Thai Massage Fundamentals
Northern Style Thai Massage
Anatomy and Palpation for Thai Massage and Yoga
Clinical Thai Bodywork Level 1 Fundamentals
Private Instruction (individual attention in half the time)
Course Repeats
20hr
20hr
16hr
ea 20hr
8hr
40hr
60hr
20hr
20hr
Price (deposit or full fee) Qty Total
$250 or $450
incl LPKs balls $250 or $500
$200 or $400
$250 or $450
$100 or $250
$400 or $800
$500 or $1000
$250 or $450
$250 or $450
$900 most classes
FREE – if part of CTB program
GUEST COURSES: __________________________________
L1, L2, L3
TBA
Thai Yoga Massage Mat regular/LARGE & w/ or w/o washable cover
Level 1, 2, 3, or HF – Thai Bodywork DVDs
$185 / $285*(cover add $50)*
$50 any single title
10% off course fees w/ registration in 3+ courses- paid in advance
i.e.
Total
Method of Payment:
Credit Card Type:
Credit Card #:
3digit CCV code or 4digit Amex:
Expiration Date:
Signature (authorization to charge card)
MAIL TO or FAX TO:
Cash
Check
Credit Card
Visa – MasterCard – American Express – Discover
The Orlando School of Thai Massage
1971 Howell Branch Road
Maitland, FL 32751
Phone: (407) 243-8424
Fax: (888) 268-9852
www.orlandoschoolofthaimassage.com
[email protected]
PLEASE READ and COMPLETE ENTIRE REGISTRATION FORM (4 PAGES)
$2450
$2200
Refund/Cancellation Policy
Should an individual cancel enrollment or be dismissed for any reasons by Orlando School of Thai Massage before
the completion of his/her program of study, all refunds will be made according to the following refund schedule.
With regard to any refunds due, Orlando School of Thai Massage will refund monies using the following
distribution:
1.
Any applicant not accepted for admission by Orlando School of Thai Massage shall be entitled to a full refund
of all monies paid.
2.
If a student cancels his/her enrollment prior to entering classes, he/she shall be entitled to a refund of all
monies paid to the school less a course cancellation fee of one-half course tuition per class.
3.
For students who enroll in and begin classes, the following schedule of tuition adjustment is authorized:
4.
Percentage of Class Competed
.01% to 4.9%
5.0% to 9.9%
10% to 14.9%
15% to 24.9%
25% to 49.9%
50% and Over
monies paid – (minus) 20%
monies paid – (minus) 30%
monies paid – (minus) 40%
monies paid – (minus) 45%
monies paid – (minus) 70%
monies paid – (minus) 100%
+ $250.00 Termination Fee
+ $250.00 Termination Fee
+ $250.00 Termination Fee
+ $250.00 Termination Fee
+ $250.00 Termination Fee
+ $250.00 Termination Fee
5.
Enrollment time is defined as the time elapsed between the actual starting date and date of the students last
physical attendance in the school. Any monies due the applicant or student shall be refunded within forty five (45)
days of formal cancellation by the student, or formal termination by the school, which shall occur no more than
thirty (30) days from the last day of physical attendance, or in the case of a Leave of Absence, the documented date
of return.
6.
In the case of illness, disabling accident, or death in the immediate family, or other extreme circumstances
beyond the control of the student, a settlement will be made which is reasonable and fair to both.
7.
Official date of termination or withdrawal for purposed of the Refund policy of Orlando School of Thai
Massage shall be the last day of physical attendance in the class or workshop venue wherever held.
8.
Any student desiring to make a change in his/her status at an Orlando School of Thai Massage sponsored
class or function must make such a request in writing by regular mail to the Administrative Director.
9.
If the school/program of study and or seminar training is permanently closed and no longer offering
instruction after the student is enrolled, the student shall be entitled to a pro-rated refund of monies paid. If a course
is cancelled subsequent to a student’s enrollment, the company shall, at its option, provide for a full refund of all
monies paid, or shall provide for an alternate completion of the course.
10. The Student Kit or other preparation and study materials are issued to the student prior to or on the first day of
the workshop, and is included as a non-refundable item in the total program cost.
11. Should the student withdraw prior to program completion, no refund for The Student Kit or other preparation
and study materials shall be made.
12. There is no refund for personal and professional items purchased as required in the program such as mats,
massage tables, oils etc.
Signature: __________________________________
Printed Name: _______________________________
Date:_________________
Student Enrollment Form
Student:______________________________
Class:_______________________________________________
Date:____________________
1. I understand that courses offered by Orlando School of Thai Massage are for
educational purposes and includes hands-on experimental training.
__________initials
2. I agree that I am solely responsible for determining the degree to which I can safely
participate,to which this may cause soreness and/or injury.
__________initials
3. I agree to indemnify and hold Rob Murray and the Orlando School of Thai Massage,
its associates, affiliates, employees and faculty members harmless in connection
with any claims resulting from my attendance.
__________initials
4. I understand that these courses are not intended to replace any medical or
psychological care that I may require, and that if I have any medical conditions that
could be impacted by this course that I am attending with my doctor’s permission.
__________initials
5. I am aware of the nature and content of the course and have read and agree to be
bound by the cancellation policies as posted on the Orlando School of Thai Massage
website.
__________initials
6. I have read, understand and agree with the above and I willingly participate in this
Orlando School of Thai Massage workshop/certification/course.
__________initials
Signed___________________________ Date________________________
Witnessed by______________________ Date________________________
ABOUT YOU
1. What is your profession?
If your profession is massage, how long have you been doing massage?
Do you need CEUs? Y / N; If yes, your FL lic#:___________.
If your profession is yoga, what kind and for how long have you been practicing and teaching?
2. How do you plan on implementing what you have learned?
3. What do you know of Thailand and the Thai culture?
4. Have you ever been to Thailand?
5. Have you ever eaten Thai food?
6. What brings you to Thai massage?
7. Have you ever had a Thai massage? If so, what kind and where did you receive it?
8. What are you most interested in learning or gaining from this experience?
9. What other courses that we offer are you interests you?
10.How did you find our school and why did you choose the Thai Bodywork method
over the other courses and certifications across the US?