Please complete all fields on our form below as best you can. If you prefer to download a PDF version of our registration form, please click here.

Registration Form



    Address - Line 1*

    Address - Line 2



    Zip Code*


    Emergency Contact Name

    Emergency Contact Phone

    Please list all previous reflexology training. Include school, location and instructors.*

    Please list all massage/healthcare education.*

    What is your primary interest in taking this class?*

    Please list all allergies, disabilities or any other conditions that affect your health so that I may support you having a healthy learning environment.*

    Anything else you would like me to know before class starts?

    Tuition & Payment Options

    • Paid In Full Two Weeks Prior To Start Date $1500
    • Paid In Full 13 Days Prior – Through To Start Date $1650
    • Make Two Payments In The Amount Of $850:
      • First Payment Due Two Weeks Prior To Start Date
      • Second Payment Due Halfway Through The Program Curriculum

    Refund Policy

    If you have registered and paid but are not able to start the program, you may stay registered and elect to choose a new start date at no extra cost. The new start date must be within three months of the original start date.


    You may receive a full refund minus a $50 processing fee. Notice of your inability to start must be made before or on your original start date.

    Completing the program

    You must complete the program within 12 months of your start date. If you do not complete you may elect to extend your program. Extensions are granted for a period of three months in length for a fee of $295.