Common use of STUDENT ACKNOWLEDGMENTS Clause in Contracts

STUDENT ACKNOWLEDGMENTS. Student Initial I understand that I must show up to class lucid, and mentally and physically rested and prepared. I understand that if the instructor feels I am not prepared I can be questioned, and if necessary dismissed from that session with the instruction to be prepared for the next session. Students, who are under the influence of alcohol, elicit drugs, prescription drugs or any other mind or body-altering substances cannot participate in class. Student Initial I understand that disruptive behavior, vulgar language or inappropriate attire will not be tolerated during class. If after a warning from an instructor or other PTS staff member the offense continues I may be asked to leave class with out the possible option to return. In this case no refunds will be given. *Scrubs are the preferred attire but are not required. Student Initial I understand the risks associated with drawing blood, contracting diseases and am aware that phlebotomy procedures in class will be performed on fellow students, volunteers and staff at Phlebotomy Training Specialists. I also understand that any injury sustained to me or the person I am performing phlebotomy on is solely my responsibility and will hold Phlebotomy Training Specialists harmless. Student Initial I understand that Phlebotomy Training Specialists does not offer job placement. However, resume assistance is available as well as an in class discussion on how to obtain and where to look for employment. Student Initial I understand that attendance is mandatory to successfully pass this course. Make up class time will be available by contacting student services only. I understand that I will not be able to schedule or attend make up classes once my registered class has concluded until my tuition is paid in full as explained under General Information on page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I must log into my student account at ▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ and check the spelling/format of my name and that how my name appears here is EXACTLY how it will appear on my certificate. I also understand that there is a $15 Fee for Certificate Reprints as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that if I cannot complete the course I originally registered for, before I can be reassigned to another class I must have all tuition paid in full. I also understand that if I need to be reassigned to a class for any reason I must contact student services to do so. Student Initial I understand the PTS Refund Policy and am aware that all requests to withdraw from the program must be done in writing as explained under General Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I will not be able to graduate or obtain my certification until I have completed the course and paid ALL tuition in full as explained under Payment/Certificate Information on page 2 of this Registration/ Enrollment Agreement. Student Initial I understand that in order to sit for the National Exam, I must have ALL tuition paid in full. I also understand that if I have not paid my National Exam fee at least ONE WEEK prior to the test date I may not be guaranteed a seat or exam on test day as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreement. I have read and understand this Registration/Enrollment Agreement and agree with the terms set forth therein. By signing below, the student agrees to pay Phlebotomy Training Specialists (“school”) the total stated tuition & fees. The school agrees to provide the occupational training in accordance with the provisions of the school’s current Catalog Volume No. 5 January 2018 (“Catalog”). Payment of all monies due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill requirements and when all financial obligations to the school have been met the school will award the Phlebotomy Technician Certificate to the student. The student and school understand that this Enrollment Agreement, WHICH INCLUDES THE REFUND POLICY may not be amended except in writing and signed by both parties. Student Signature Date Authorized Representative In consideration of the opportunity to receive phlebotomy instruction, training, and other services from Phlebotomy Training Specialists (“PTS”), I agree to the following. Although PTS has taken reasonable steps to make the services provided by PTS safe in an effort to avoid injury, I acknowledge and agree that there are inherent risks of physical injury and other damages associated with phlebotomy instruction and training that remain to exist. These inherent risks include, but are not limited to, injury caused by in-class attempts to draw blood from each other by the participants, like myself, receiving instruction and training from PTS. I understand that the above description of risks associated with the phlebotomy instruction and training is not complete, and that other unknown or unanticipated risks may, however very unlikely, result in injury or death. My participation in phlebotomy instruction and training is purely voluntary, based upon my own assessment of all relevant facts and circumstances, in spite of the associated risks. I acknowledge that I am not relying on any oral, written or visual representations made by PTS, including those made in its brochures or other promotional material, in deciding to voluntarily accept the risks associated with my participation in this phlebotomy instruction and training. I hereby agree to accept the risk of any such injury or damage; in addition I agree not to hold PTS, or any of its owners, employees or agents, responsible in any way for any injuries or damages I may incur during, or related in any manner to, the phlebotomy instruction and training I will receive from PTS, even if PTS or its employees or agents act negligently. I also understand that PTS is neither responsible nor liable for my travel to and from classes. I come and go of my own free will and choice and agree not to hold PTS accountable in any way should I become injured in any manner during those travels. In the event I incur any injury arising from, or related in any manner to, my participation in any phlebotomy instruction or training I receive from PTS, I will immediately notify a PTS instructor of the nature and cause of such injury. I hereby agree to defend, indemnify and hold PTS and its owners, employees and agents harmless from any liability, damages or other costs, including, but not limited to, attorney fees and other costs of litigation, related to, or arising from, my participation in any phlebotomy instruction or training I receive from PTS and/or any of my activities related thereto. The prevailing party in any legal action to interpret and/or enforce any of the terms of this Release of Liability shall also be awarded their reasonable attorney fees and other costs and expenses incurred regarding that legal action. This Release of Liability shall be governed by the laws of the State of Utah. Any dispute between me and PTS shall, upon the written demand of either party, be submitted to arbitration before a single arbitrator whose decision shall be binding and conclusive on all parties. Such arbitration shall generally comply with the arbitration rules of the American Arbitration Association (“AAA”), but need not be conducted or otherwise administered by the AAA, and such arbitration shall be conducted by a provider of arbitration services other than the AAA upon the demand of either party. Such arbitration shall be conducted in the State of Utah regardless of where I received phlebotomy instruction or training and regardless of where I may be located at the time of such dispute. Student Signature Date Printed Name Location of Training: Class Start Date: _ In addition to our employment presentation given during class, we offer resume review. Just send the most recent copy of your resume to ▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ and one of our staff members will review and provide feedback within 72 hours. Student Name _ Phone # Male Female _ Address City State Zip County SSN (Last 4 digits): Email DOB (MM/DD/YYYY) Are you on disability? Yes No Are you a Veteran? Yes NO Ethnicity: Hispanic/Latino Hawaiian/Pacific Islander Asian Caucasian Native/AlaskanAmerican African American

STUDENT ACKNOWLEDGMENTS. Student Initial I understand that I must show up to class lucid, have received and mentally and physically rested and prepared. I understand that if the instructor feels I am not prepared I can be questioned, and if necessary dismissed from that session with the instruction to be prepared for the next session. Students, who are under the influence read a copy of alcohol, elicit drugs, prescription drugs or any other mind or body-altering substances cannot participate in class. Student Initial I understand that disruptive behavior, vulgar language or inappropriate attire will not be tolerated during class. If after a warning from an instructor or other PTS staff member the offense continues I may be asked to leave class with out the possible option to return. In this case no refunds will be given. *Scrubs are the preferred attire but are not required. Student Initial I understand the risks associated with drawing blood, contracting diseases and am aware that phlebotomy procedures in class will be performed on fellow students, volunteers and staff at Phlebotomy Training Specialists. I also understand that any injury sustained to me or the person I am performing phlebotomy on is solely my responsibility and will hold Phlebotomy Training Specialists harmless. Student Initial I understand that Phlebotomy Training Specialists does not offer job placement. However, resume assistance is available as well as an in class discussion on how to obtain and where to look for employment. Student Initial I understand that attendance is mandatory to successfully pass this course. Make up class time will be available by contacting student services only. I understand that I will not be able to schedule or attend make up classes once my registered class has concluded until my tuition is paid in full as explained under General Information on page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I must log into my student account The Art Institute’s current catalog located at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ and check ▇/flyover/catalogs/11, the spelling/format provisions of my name and that how my name appears here is EXACTLY how it will appear on my certificate. which I also understand that there is a $15 Fee for Certificate Reprints as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that if I cannot complete the course I originally registered for, before I can be reassigned to another class I must have all tuition paid in full. I also understand that if I need to be reassigned to a class for any reason I must contact student services to do so. Student Initial I understand the PTS Refund Policy and am aware that all requests to withdraw from the program must be done in writing as explained under General Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I will not be able to graduate or obtain my certification until I have completed the course and paid ALL tuition in full as explained under Payment/Certificate Information on page 2 of this Registration/ Enrollment Agreement. Student Initial I understand that in order to sit for the National Exam, I must have ALL tuition paid in full. I also understand that if I have not paid my National Exam fee at least ONE WEEK prior to the test date I may not be guaranteed a seat or exam on test day as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreementaccept. I have read and understand all provisions of this Registration/Enrollment Agreement Agreement, and agree I have been given a copy of it for my records. I accept that, to the extent permitted by law, I am responsible for all reasonable collection agency and attorney fees incurred in attempting to collect any unpaid debts to The Art Institute. If I elect a financial aid plan, the plan will be in compliance with the terms set forth therein. By signing below, the student agrees to pay Phlebotomy Training Specialists (“school”) the total stated tuition & fees. The school agrees to provide the occupational training Federal Truth in accordance with the provisions of the school’s current Catalog Volume No. 5 January 2018 (“Catalog”). Payment of all monies due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill Lending retail installment requirements and when all financial obligations to the school have been met the school will award the Phlebotomy Technician Certificate to the student. The student and school understand that plan becomes a part of this Enrollment Agreement. (Parents or Guardian must also sign if you are under 18 years of age.) I understand that my enrollment and The Art Institute’s obligations under this Enrollment Agreement (except the cancellation and refund provisions) may be terminated by The Art Institute if I fail to comply with The Art Institute’s attendance, WHICH INCLUDES THE REFUND POLICY may not be amended except in writing and signed by both parties. Student Signature Date Authorized Representative In consideration of the opportunity to receive phlebotomy instructionconduct, trainingacademic, and other services from Phlebotomy Training Specialists (“PTS”), I agree to the following. Although PTS has taken reasonable steps to make the services provided by PTS safe in an effort to avoid injury, I acknowledge and agree that there are inherent risks of physical injury and other damages associated with phlebotomy instruction and training that remain to exist. These inherent risks include, but are not limited to, injury caused by in-class attempts to draw blood from each other by the participants, like myself, receiving instruction and training from PTSand/or financial requirements. I understand that The Art Institute also reserves the above description of risks associated with the phlebotomy instruction and training is not complete, and that other unknown or unanticipated risks may, however very unlikely, result in injury or death. My participation in phlebotomy instruction and training is purely voluntary, based upon right to cancel my own assessment of all relevant facts and circumstances, in spite of the associated risks. I acknowledge enrollment if The Art Institute determines (i) that I am not relying on any oralhave demonstrated poor academic potential as determined through entrance testing, written or visual representations made by PTS, including those made in its brochures or other promotional material, in deciding to voluntarily accept the risks associated with my participation in this phlebotomy instruction and training. I hereby agree to accept the risk evaluation of any such injury or damage; in addition I agree not to hold PTStranscript records, or any other academic evaluations deemed appropriate for the program selected, and/or (ii) that I do not meet all financial obligations related to enrollment and continuing enrollment. I understand that my financial obligations to The Art Institute must be paid in full before a degree may be awarded and before transcripts will be issued. The Enrollment Agreement and catalog, together with other published The Art Institute policies, procedures, student conduct codes, and separate college-sponsored housing agreement, if any, shall constitute the entire agreement between the student and The Art Institute. I understand and agree that they supersede any prior or contemporaneous oral or written agreements or statements and may not be modified without the written agreement of its owners, employees or agents, responsible in any way for any injuries or damages I may incur during, or related in any manner to, the phlebotomy instruction and training I will receive from PTS, even if PTS or its employees or agents act negligentlyPresident of The Art Institute. I also understand that PTS is neither responsible nor liable for my travel to and from classes. I come and go of my own free will and choice and agree not to hold PTS accountable in any way should I become injured in any manner during those travels. In the event I incur any injury arising from, or related in any manner to, my participation in any phlebotomy instruction or training I receive from PTS, I will immediately notify this Agreement constitutes a PTS instructor of the nature and cause of such injury. I hereby agree to defend, indemnify and hold PTS and its owners, employees and agents harmless from any liability, damages or other costs, including, but not limited to, attorney fees and other costs of litigation, related to, or arising from, my participation in any phlebotomy instruction or training I receive from PTS and/or any of my activities related thereto. The prevailing party in any legal action to interpret and/or enforce any of the terms of this Release of Liability shall also be awarded their reasonable attorney fees and other costs and expenses incurred regarding that legal action. This Release of Liability shall be governed by the laws of the State of Utah. Any dispute between me and PTS shall, binding contract upon the written demand acceptance by The Art Institute. Any holder of either party, be submitted this consumer credit contract is subject to arbitration before a single arbitrator whose decision shall be binding all claims and conclusive on all parties. Such arbitration shall generally comply defenses that the debtor could assert against the seller of goods or services obtained pursuant hereto or with the arbitration rules of the American Arbitration Association (“AAA”), but need not be conducted or otherwise administered proceeds hereof. Recovery hereunder by the AAA, debtor shall not exceed the amount paid by the debtor. My signature below signifies that I have read and such arbitration shall be conducted by a provider understand all aspects of arbitration services other than the AAA upon the demand of either party. Such arbitration shall be conducted this Agreement and do recognize my legal responsibilities in the State of Utah regardless of where I received phlebotomy instruction or training and regardless of where I may be located at the time of such dispute. Student Signature Date Printed Name Location of Training: Class Start Date: _ In addition regard to our employment presentation given during class, we offer resume review. Just send the most recent copy of your resume to ▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇this Agreement.▇▇▇ and one of our staff members will review and provide feedback within 72 hours. Student Name _ Phone # Male Female _ Address City State Zip County SSN (Last 4 digits): Email DOB (MM/DD/YYYY) Are you on disability? Yes No Are you a Veteran? Yes NO Ethnicity: Hispanic/Latino Hawaiian/Pacific Islander Asian Caucasian Native/AlaskanAmerican African American

STUDENT ACKNOWLEDGMENTS. Student Initial I have read and understand all provisions of this agreement, and I have been given a copy of it for my records. (Parents must also sign if you are under 18 years of age.) I understand that my enrollment and The Art Institute’s obligations under this Enrollment Agreement (except the cancellation and refund provisions) may be terminated by The Art Institute if I must show up fail to class lucidcomply with The Art Institute’s attendance, conduct, academic, and/or financial requirements. I understand that The Art Institute also reserves the right to deny my enrollment if it is determined (i) that I have demonstrated poor academic potential as determined through evaluation of transcript records or any other academic evaluations deemed appropriate for the program selected, and/or (ii) that I do not meet all financial obligations related to enrollment and mentally continuing enrollment. I understand that my financial obligations to The Art Institute mustbepaidinfullbeforeadiplomaordegree may be awarded and physically rested and preparedbefore transcripts will be issued. I understand that if I obtain a loan to pay for an educational program, I will have the instructor feels responsibility to repay the full amount of the loan plus interest, less the amount of any refund. I further understand that if I am eligible for a loan guaranteed by the federal or state government and I default on the loan, one or both of the following may occur: 1.) The federal or state government or a loan guarantee agency may take action against me, which includes applying any income tax refund to which the person is entitled to reduce the balance owed on the loan, 2.) I may not prepared I can be questioned, and if necessary dismissed from that session with the instruction to be prepared eligible for the next session. Students, who are under the influence of alcohol, elicit drugs, prescription drugs or any other mind or body-altering substances cannot participate in class. Student Initial I understand that disruptive behavior, vulgar language or inappropriate attire will not be tolerated during class. If after a warning from an instructor federal student financial aid at another institution or other PTS staff member government assistance until the offense continues I may be asked loan is repaid. Iacceptthat, to leave class with out the possible option theextentpermittedbylaw, Iamresponsibleforallreasonable collection agency and attorney fees incurred in attempting to return. In this case no refunds will be given. *Scrubs are the preferred attire but are not required. Student Initial I understand the risks associated with drawing blood, contracting diseases and am aware that phlebotomy procedures in class will be performed on fellow students, volunteers and staff at Phlebotomy Training Specialistscollect my unpaid debt to The Art Institute. I also understand that any injury sustained this agreement constitutes a binding contract upon signature by student and acceptance by The Art Institute. Any holder of this consumer credit contract is subject to me all claims and defenses which the debtorcouldassertagainstthesellerofgoodsorservicesobtainedpursuant hereto or with the person I am performing phlebotomy on is solely my responsibility and will hold Phlebotomy Training Specialists harmlessproceeds hereof. Student Initial I understand that Phlebotomy Training Specialists does Recovery here under by the debtor shall not offer job placementexceed amounts paid by the debtor. However, resume assistance is available as well as an in class discussion on how to obtain and where to look for employment. Student Initial I understand that attendance is mandatory to successfully pass this course. Make up class time will be available by contacting student services only. I understand My signature signifies that I will not be able have readandunderstandallaspectsofthisagreementanddorecognizemylegal responsibilities in regard to schedule or attend make up classes once my registered class has concluded until my tuition is paid in full as explained under General Information on page 2 this contract. Supplies: $100/month Texts: $75/month The starting kit consists of this Registration/Enrollment Agreementbasic equipment, first-quarter textbooks, and material needed for beginning each program. Student Initial I understand that I must log into my student account at ▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ and check the spelling/format of my name and that how my name appears here is EXACTLY how it will appear on my certificate. I also understand that there is a $15 Fee for Certificate Reprints as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that if I cannot complete the course I originally registered for, before I can be reassigned to another class I must have all tuition paid in full. I also understand that if I need to be reassigned to a class for any reason I must contact student services to do so. Student Initial I understand the PTS Refund Policy and am aware that all requests to withdraw from the program must be done in writing as explained under General Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I will not be able to graduate or obtain my certification until I have completed the course and paid ALL tuition in full as explained under Payment/Certificate Information on page 2 of this Registration/ Enrollment Agreement. Student Initial I understand that in order to sit for the National Exam, I must have ALL tuition paid in full. I also understand that if I have not paid my National Exam fee at least ONE WEEK prior to the test date I may not be guaranteed a seat or exam on test day as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreement. I have read and understand this Registration/Enrollment Agreement and agree with the terms set forth therein. By signing below, the student agrees to pay Phlebotomy Training Specialists (“school”) the total stated tuition & fees. The school agrees to provide the occupational training in accordance with the provisions A list of the school’s current Catalog Volume No. 5 January 2018 (“Catalog”). Payment components of all monies due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill requirements and when all financial obligations the starting kit is provided to the school have been met the school will award the Phlebotomy Technician Certificate to the each enrolled student. The student and school understand that this Enrollment Agreement, WHICH INCLUDES THE REFUND POLICY may not be amended except in writing and signed by both parties. Student Signature Date Authorized Representative In consideration of the opportunity to receive phlebotomy instruction, training, and other services from Phlebotomy Training Specialists (“PTS”), I agree to the following. Although PTS has taken reasonable steps to make the services provided by PTS safe in an effort to avoid injury, I acknowledge and agree that there are inherent risks of physical injury and other damages associated with phlebotomy instruction and training that remain to exist. These inherent risks include, but are not limited to, injury caused by in-class attempts to draw blood from each other by the participants, like myself, receiving instruction and training from PTS. I understand that the above description of risks associated with the phlebotomy instruction and training is not complete, and that other unknown or unanticipated risks may, however very unlikely, result in injury or death. My participation in phlebotomy instruction and training is purely voluntary, based upon my own assessment of all relevant facts and circumstances, in spite of the associated risks. I acknowledge that I am not relying on any oral, written or visual representations made by PTS, including those made in its brochures or other promotional material, in deciding to voluntarily accept the risks associated with my participation in this phlebotomy instruction and training. I hereby agree to accept the risk of any such injury or damage; in addition I agree not to hold PTS, or any of its owners, employees or agents, responsible in any way for any injuries or damages I may incur during, or related in any manner to, the phlebotomy instruction and training I will receive from PTS, even if PTS or its employees or agents act negligently. I also understand that PTS is neither responsible nor liable for my travel to and from classes. I come and go of my own free will and choice and agree not to hold PTS accountable in any way should I become injured in any manner during those travels. In the event I incur any injury arising from, or related in any manner to, my participation in any phlebotomy instruction or training I receive from PTS, I will immediately notify a PTS instructor of the nature and cause of such injury. I hereby agree to defend, indemnify and hold PTS and its owners, employees and agents harmless from any liability, damages or other costs, including, but not limited to, attorney fees and other costs of litigation, related to, or arising from, my participation in any phlebotomy instruction or training I receive from PTS and/or any of my activities related thereto. The prevailing party in any legal action to interpret and/or enforce any of the terms of this Release of Liability shall also be awarded their reasonable attorney fees and other costs and expenses incurred regarding that legal action. This Release of Liability shall be governed by the laws of the State of Utah. Any dispute between me and PTS shall, upon the written demand of either party, be submitted to arbitration before a single arbitrator whose decision shall be binding and conclusive on all parties. Such arbitration shall generally comply with the arbitration rules of the American Arbitration Association (“AAA”), but need not be conducted or otherwise administered by the AAA, and such arbitration shall be conducted by a provider of arbitration services other than the AAA upon the demand of either party. Such arbitration shall be conducted in the State of Utah regardless of where I received phlebotomy instruction or training and regardless of where I materials may be located purchased at the time of such disputeThe Art Institute or most supply stores. Student Signature Date Printed Name Location of Training: Class Start Date: _ In addition to our employment presentation given during class, we offer resume review. Just send the most recent copy of your resume to ▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇Kit is optional.▇▇▇ and one of our staff members will review and provide feedback within 72 hours. Student Name _ Phone # Male Female _ Address City State Zip County SSN (Last 4 digits): Email DOB (MM/DD/YYYY) Are you on disability? Yes No Are you a Veteran? Yes NO Ethnicity: Hispanic/Latino Hawaiian/Pacific Islander Asian Caucasian Native/AlaskanAmerican African American

STUDENT ACKNOWLEDGMENTS. Student Initial I understand that I must show up to class lucidhave received and read a copy of The Art Institute of Wisconsin (“The Art Institute”) current catalog, and mentally and physically rested and prepared. I understand that if the instructor feels I am not prepared I can be questioned, and if necessary dismissed from that session with the instruction to be prepared for the next session. Students, who are under the influence of alcohol, elicit drugs, prescription drugs or any other mind or body-altering substances cannot participate either in class. Student Initial I understand that disruptive behavior, vulgar language or inappropriate attire will not be tolerated during class. If after a warning from an instructor or other PTS staff member the offense continues I may be asked to leave class with out the possible option to return. In this case no refunds will be given. *Scrubs are the preferred attire but are not required. Student Initial I understand the risks associated with drawing blood, contracting diseases and am aware that phlebotomy procedures in class will be performed on fellow students, volunteers and staff at Phlebotomy Training Specialists. I also understand that any injury sustained to me printed form or the person I am performing phlebotomy on is solely my responsibility and will hold Phlebotomy Training Specialists harmless. Student Initial I understand that Phlebotomy Training Specialists does not offer job placement. However, resume assistance is available as well as an in class discussion on how to obtain and where to look for employment. Student Initial I understand that attendance is mandatory to successfully pass this course. Make up class time will be available by contacting student services only. I understand that I will not be able to schedule or attend make up classes once my registered class has concluded until my tuition is paid in full as explained under General Information on page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I must log into my student account at online version (▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ and check ▇/flyover/catalogs/138), the spelling/format provisions of my name and that how my name appears here is EXACTLY how it will appear on my certificate. which I also understand that there is a $15 Fee for Certificate Reprints as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that if I cannot complete the course I originally registered for, before I can be reassigned to another class I must have all tuition paid in full. I also understand that if I need to be reassigned to a class for any reason I must contact student services to do so. Student Initial I understand the PTS Refund Policy and am aware that all requests to withdraw from the program must be done in writing as explained under General Information on Page 2 of this Registration/Enrollment Agreement. Student Initial I understand that I will not be able to graduate or obtain my certification until I have completed the course and paid ALL tuition in full as explained under Payment/Certificate Information on page 2 of this Registration/ Enrollment Agreement. Student Initial I understand that in order to sit for the National Exam, I must have ALL tuition paid in full. I also understand that if I have not paid my National Exam fee at least ONE WEEK prior to the test date I may not be guaranteed a seat or exam on test day as explained under Payment/Certificate/Exam Information on Page 2 of this Registration/Enrollment Agreementaccept. I have read and understand all provisions of this Registration/agreement, and I have been given a copy of it for my records. (Parents must also sign if you are under 18 years of age.) I understand that my enrollment and The Art Institute’s obligations under this Enrollment Agreement (except the cancellation and agree refund provisions) may be terminated by The Art Institute if I fail to comply with the terms set forth therein. By signing belowThe Art Institute’s attendance, the student agrees to pay Phlebotomy Training Specialists (“school”) the total stated tuition & fees. The school agrees to provide the occupational training in accordance with the provisions of the school’s current Catalog Volume No. 5 January 2018 (“Catalog”). Payment of all monies due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill requirements and when all conduct, academic, and/or financial obligations to the school have been met the school will award the Phlebotomy Technician Certificate to the student. The student and school understand that this Enrollment Agreement, WHICH INCLUDES THE REFUND POLICY may not be amended except in writing and signed by both parties. Student Signature Date Authorized Representative In consideration of the opportunity to receive phlebotomy instruction, training, and other services from Phlebotomy Training Specialists (“PTS”), I agree to the following. Although PTS has taken reasonable steps to make the services provided by PTS safe in an effort to avoid injury, I acknowledge and agree that there are inherent risks of physical injury and other damages associated with phlebotomy instruction and training that remain to exist. These inherent risks include, but are not limited to, injury caused by in-class attempts to draw blood from each other by the participants, like myself, receiving instruction and training from PTSrequirements. I understand that The Art Institute also reserves the above description right to deny my enrollment if The Art Institute determines (i) that I have demonstrated poor academic potential as determined through evaluation of risks associated with transcript records or any other academic evaluations deemed appropriate for the phlebotomy instruction program selected, and/or (ii) that I do not meet all financial obligations related to enrollment and training is not complete, and that other unknown or unanticipated risks may, however very unlikely, result in injury or death. My participation in phlebotomy instruction and training is purely voluntary, based upon my own assessment of all relevant facts and circumstances, in spite of the associated riskscontinuing enrollment. I acknowledge understand that I am not relying on any oral, written or visual representations made by PTS, including those made in its brochures or other promotional material, in deciding my financial obligations The student is responsible for tuition and fees pertaining to voluntarily accept the risks associated with my participation program’s required course of study. The tuition and fees contained in this phlebotomy instruction and training. I hereby agree Enrollment Agreement are subject to accept the risk of any such injury or damage; in addition I agree not to hold PTS, or any of its owners, employees or agents, responsible in any way for any injuries or damages I may incur during, or related in any manner to, the phlebotomy instruction and training I will receive from PTS, even if PTS or its employees or agents act negligently. I also understand that PTS is neither responsible nor liable for my travel to and from classes. I come and go of my own free will and choice and agree not to hold PTS accountable in any way should I become injured in any manner during those travels. In the event I incur any injury arising from, or related in any manner to, my participation in any phlebotomy instruction or training I receive from PTS, I will immediately notify a PTS instructor of the nature and cause of such injury. I hereby agree to defend, indemnify and hold PTS and its owners, employees and agents harmless from any liability, damages or other costs, including, but not limited to, attorney fees and other costs of litigation, related to, or arising from, my participation in any phlebotomy instruction or training I receive from PTS and/or any of my activities related theretochange. The prevailing party in any legal action per credit hour rate is subject to interpret and/or enforce any of an increase at least once per calendar year which will increase the terms of this Release of Liability shall also total amount for the program. The adjustment to the per credit hour rate may occur before the student begins classes and the student’s program will be awarded their reasonable attorney fees and other costs and expenses incurred regarding that legal action. This Release of Liability shall be governed by calculated using the laws of the State of Utahnew rate. Any dispute between me changes to tuition and PTS shall, upon fees will be published to students. Re-entering students will be subject to the written demand of either party, be submitted to arbitration before a single arbitrator whose decision shall be binding and conclusive on all parties. Such arbitration shall generally comply with the arbitration rules of the American Arbitration Association (“AAA”), but need not be conducted or otherwise administered by the AAA, and such arbitration shall be conducted by a provider of arbitration services other than the AAA upon the demand of either party. Such arbitration shall be conducted in the State of Utah regardless of where I received phlebotomy instruction or training and regardless of where I may be located current per credit hour tuition charge at the time of such disputere-enrollment. Student Signature Date Printed Name Location Each school quarter is approximately 11 weeks. An application fee of Training: Class Start Date: _ $50 is to be submitted with the Application for Admission. The enrollment fee of $100 is due within 10 days after the Enrollment Agreement is signed. Special U.S. and overseas trips are voluntary and are not included in regular tuition and fees. If a student elects to enter into a financial plan, the financial plan will be in compliance with the Federal Truth in Lending installment requirements and will become a part of this Enrollment Agreement. The Starting Kits are mandatory for all Culinary programs and optional for all other programs. They consist of some of the basic equipment, first-quarter textbooks, and materials needed for beginning each program. A list of the components of the Starting Kit is provided to each enrolled student. These materials may be purchased at The Art Institute or at most supply stores. In addition to our employment presentation given during classthe Starting Kit, we offer resume review. Just send the most recent copy average costs of your resume to ▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ consumable supplies, textbooks, and one of our staff members will review and provide feedback within 72 hours. Student Name _ Phone # Male Female _ Address City State Zip County SSN (Last 4 digits): Email DOB (MM/DD/YYYY) Are you on disability? Yes No Are you a Veteran? Yes NO Ethnicity: Hispanic/Latino Hawaiian/Pacific Islander Asian Caucasian Native/AlaskanAmerican African Americanequipment by program are as follows: