Reflexology Registration Form Student Information Full Name * First Name Last Name Company If Applicable First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Contact in case of emergency (Relationship): * Birthday * MM DD YYYY Occupation * Education (Highest) * Start Date of Program * MM DD YYYY How did you hear about us? Terms & Conditions * By signing up for this class, I acknowledge and agree to the terms and policies, and liability and release waiver of the class. TERMS & POLICIES FOR CERTIFICATION PROGRAM Payment Policy: No refunds or credits are issued for certification courses within two-weeks of the class date. Prior to two-weeks of the class date, 80% of the class fee can be transferred to another course and used within 6 months of the issue date. Attendance policy: Requirements for the Certification Programs must be completed within 2 years of starting the Program. The full duration of each class must be attended. Arriving late or departing early will require you to re-take that portion of the class. Private tutoring is available in certain instances at an additional 50% of course fee. Classroom etiquette: Students should treat their classmates and instructors with kindness and respect and maintain a receptive and collaborative demeanor. Students should mute their phones and avoid phone use unless during emergencies or breaks. There is strictly no texting or surfing the internet during class. There is strictly no recording of the course. Preparing for class Students are encouraged to wear comfortable clothing and dress in layers to class. Blankets, cushions and comfortable seating is provided at the School. Students are welcome to bring snacks and lunch that does not require heating or cooking. Food is not allowed in our classrooms and should be eaten during regular breaks. Students should bring a notebook to write in. A class manual and handouts are provided for each Certification course and should be brought to subsequent classes. Certification policy: A completion certificate is provided by ASOW upon completion of class requirements. Certification is issued by independent certification bodies after meeting their requirements. ASOW does not take any responsibility for students passing national exams or meeting the certification requirements set by the certification organizations. Scope of practice is defined by and regulated by state governing bodies. Students are responsible for checking the legality and requirements for practicing within their jurisdictions. ASOW does not take any responsibility for the student’s ability to practice and earn wages. I agree I don't agree Liability Waiver & Release Agreement * Class/Activity Name: Certification Programs Organization Name: Atlanta School of Wellness / Ranesa House of Wellness Acknowledgment and Assumption of Risk: I, the undersigned, acknowledge and understand that participation in the above-mentioned class/activity involves certain inherent risks, including but not limited to physical injury, illness, or emotional distress. I understand that these risks may arise from my own actions, the actions of others, or the condition of the facilities and equipment used. I voluntarily assume all risks associated with my participation in the class/activity and agree to hold harmless and release the instructor/organization, its officers, employees, volunteers, and agents from any and all claims, demands, or causes of action arising out of or related to any injury or harm that may result from my participation in the class/activity, whether caused by negligence or otherwise. Medical Emergency: In the event of a medical emergency, I authorize the instructor or designated representatives of the organization to seek emergency medical care for me. I agree to bear all costs associated with such care. Fitness to Participate: I certify that I am physically and mentally capable of participating in the class/activity and that I have disclosed any pre-existing conditions, injuries, or concerns that may affect my ability to participate. If I am unsure about my fitness for participation, I will consult a medical professional prior to participating. Indemnification: I agree to indemnify and hold harmless the instructor/organization from any loss, liability, damages, or costs (including legal fees) incurred because of any injury, illness, or damages caused by my participation in the class/activity. Photography/Video Release: I consent to the recording of my image, voice, or likeness during the class/activity, and I grant permission for the instructor/organization to use these recordings for promotional, educational, or other purposes. Acknowledgment By agreeing below, the student acknowledges that they have read, understood, and agree to the terms and conditions, and liability waiver set forth above. I agree I don't agree Name First Name Last Name Date MM DD YYYY Thank you for submitting your reflexology Certification Form! We will get back to you within 48 hours! If you have any questions please reach out to classes@raneshouse.com.