HLC ENROLLMENT APPLICATION Please print out and mail to: HOLISTIC LEARNING CENTER 1509 LAKESIDE DR SO FORKED RIVER NJ 08731

Applicant's Full Name _________________________________ Home Telephone ___________________ E-mail __________________________________ Work or Cell Number __________________________ Address (street address) ________________________________________________________________ City, State & Zip Code _________________________________________________________________ Shipping Address if different from home address Address (street address) ________________________________________________________________ City, State & Zip Code _________________________________________________________________ I request enrollment in:  __________________________________________________________________ Payment Method requested _________________________ I am making a payment of $________________ If paying by CREDIT CARD you must complete the following: Social Security # ________________________________ Date of Birth _______________________ Driver's License Number _______________________________ State ____________________ Credit Card # _________________________________________________Exp.____________ 3 digit code # on back of Credit Card____________ Exact billing address of Credit Card if different from home address Address (street address) _________________________________________________________ City, State & Zip Code __________________________________________________________ Name on Account__________________________ Signature _____________________________ [ ] Please check here and complete the above, if you wish to have HLC automatically charge your monthly payments to your CREDIT CARD for you each month.

TUITION PROTECTION AGREEMENT

COURSE WITHDRAWAL POLICY To withdraw from any HLC's courses the student needs to notify HLC in writing. The postmark date will help HLC to determine what refund the student will receive. If the student withdraws within 30 days of their enrollment and have not completed any of the coursework, the student will receive a complete refund of the paid tuition, less a $50 administrative fee. If the student withdraws after 30 days, but before 60 days, the student will receive up to 50% of the tuition paid, less a $50 administrative fee. If the student has been enrolled for more than 60 days, no refund will be given. Refunds will only be issued after all books and materials have been returned to HLC in reusable condition. Shipping costs are non-refundable. If you need to go on sabbatical because of an emergency for a time period not greater than 90 days, call your HLC service educator and something will be arranged. HOME-STUDY COURSES are the only HLC courses that must be paid in full at time of enrollment. PERIOD ALLOWED for course completion is 24-months. Upon successful completion of your program and financial obligation, you will be awarded an authorized diploma. If a 6-month extension is needed, the student may request it in writing and it will not be unduly withheld, but course completion cannot exceed a 30-month period. A REINSTATEMENT FEE of 20% of the current tuition fee will be charged for the reactivation of a previously cancelled enrollment within 24-months of cancellation, unless HLC has agreed in writing to grant the student a sabbatical period. YOUR FIRST MONTHLY PAYMENT will be due 30 days or more after your Enrollment Agreement is accepted. Other payments will be due on the same day of the month as your first payment. Under the law, you have the right to pay off the full amount full in advance. The total tuition for the course you select includes the complete program as described in our literature as the date of this agreement and all materials are yours to keep. Holistic Learning Centers reserves the right to update and substitute program materials as long as the instructional content is not changed. In the event an amount equal to one payment is outstanding for more than ten (10) days, your total program price will become immediately due and payable if you do not cure the default within fifteen (15) days of our notice to you. In no event shall Holistic Learning Center be liable for any consequential, punitive, or multiple damages of any kind. You will be charged a late fee of $5.00 for each monthly payment, which is not paid within ten days of its due date. If you submit as a payment under this Agreement by check, draft or money order, which is dishonored, you will be charged a fee of $20.00. Students in Canada and foreign countries assume payment of custom duties and any differences in exchange rates. You may notify HLC of your intent to cancel or withdraw by mail, addressed to Holistic Learning Center, 1509 Lakeside Drive S, Forked River, New Jersey 08731. NOTICE TO THE BUYER: This is a retail installment contract, and the truth in lending disclosures below applies. Do not sign this agreement before you read it or if it contains any blank space. If this agreement is accepted, we will send you an endorsed copy. If this agreement is not accepted, all money you have paid will be promptly refunded. Any holder of this consumer credit contract is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed amounts paid by debtor hereunder. GUARANTY: For good and valuable consideration, the undersigned hereby unconditionally guarantees to Holistic Learning Centers the prompt payment when due of all students tuition fees or other payments due under this Agreement. The undersigned waives all defenses of notice, presentment, consent or any other circumstance, which might otherwise constitute a legal or equitable defense or discharge of the guarantor. YOUR SIGNATURE: The terms of this contract are contained on both sides of this Student Enrollment Form. Your signature below indicates that you have read, understood and accepted the terms of both sides of this Enrollment Form, as well as the enclosed information describing your program selection. You are not bound by this enrollment until a representative of HLC accepts it. Student's Signature ________________________________________ Date____________________