REGISTRATION FORM
STUDENT ID NUMBER TERM______________________________
LAST NAME
FIRST NAME
COURSES
COURSE CODE
SECT
CREDITS
P/F/A
COURSE TITLE
By registering for class(es) and signing below you agree to be bound by the terms and
conditions on the second side of this form:
SIGNATURE/DATE: ___________________________________________________________________________________
1. PAYMENT OF FEES/PROMISE TO PAY: I understand that when I register for any class at Sacred Heart University or receive
any service from Sacred Heart University I accept full responsibility to pay all tuition, fees, and other associated costs assessed as a
result of my registration and/or receipt of services. I further understand and agree that my registration and acceptance of these
terms constitutes a promissory note agreement (i.e., a financial obligation in the form of an educational loan as defined by the U.S.
Bankruptcy Code at 11 U.S.C. §523(a)(8)) in which Sacred Heart University is providing me educational services, deferring some or
all of my payment obligation for those services, and I promise to pay for all assessed tuition, fees, and other associated costs
by the published or assigned due date. I understand and agree that if I drop or withdraw from some or all of the classes for which
I register, I will be responsible for paying all or a portion of tuition and fees in accordance with the published tuition refund schedule
at Sacred Heart University's Withdrawal Refund Policy webpage located at the following URL: www.sacredheart.edu/offices--
departments-directory/student-accounts/withdrawal--refund-policy/. I have read the terms and conditions of the published tuition
refund schedule and understand those terms are incorporated herein by reference. I further understand that my failure to attend
class or receive a bill does not absolve me of my financial responsibility as described above.
2. DELINQUENT ACCOUNT/COLLECTION: Financial hold. I understand and agree that if I fail to pay my student account bill or
any monies due and owing Sacred Heart University by the scheduled due date, Sacred Heart University will place a financial hold
on my student account, preventing me from registering for future classes, requesting transcripts, or receiving my diploma. Late
payment charge. I understand and agree that if I fail to pay my student account bill or any monies due and owing Sacred Heart
University by the scheduled due date, Sacred Heart University will assess late payment and/or finance charges at the rate of .75%
per month (annual rate of 9%) on the past due portion of my student account until my past due account is paid in full. Such interest
to be computed from the original due date. Collection agency fees. I understand and accept that if I fail to pay my student account
bill or any monies due and owing Sacred Heart University by the scheduled due date, and fail to make acceptable payment
arrangements to bring my account current, Sacred Heart University may refer my delinquent account to a collection agency. I further
understand that if Sacred Heart University refers my student account balance to a third party for collection, a collection fee will be
assessed and will be due in full at the time of the referral to the third party. The collection fee will be calculated at the maximum
amount permitted by applicable law, but not to exceed 15% of the amount outstanding. For purposes of this provision, the third party
may be a debt collection company or an attorney. If a lawsuit is filed to recover an outstanding balance, I shall also be responsible
for any costs associated with the lawsuit such as court costs or other applicable costs. Finally, I understand that my delinquent
account may be reported to one or more of the national credit bureaus.
3. COMMUNICATION: Method of communication. I understand and agree that Sacred Heart University uses e-mail as an official
method of communication with me, and that therefore I am responsible for reading the e-mails I receive from Sacred Heart
University on a timely basis. Contact. I authorize Sacred Heart University and its agents and contractors to contact me at my
current and any future cellular phone number(s), e-mail address(es), or wireless device(s) regarding my delinquent student
account(s)/loan(s), any other debt I owe to Sacred Heart University, or to receive general information from Sacred Heart University. I
authorize Sacred Heart University and its agents and contractors to use automated telephone dialing equipment, artificial or
prerecorded voice or text messages, and personal calls and e-mails, in their efforts to contact me. Furthermore, I understand that I
may withdraw my consent to call my cellular telephone using automated telephone dialing equipment by submitting my request in
writing to {Institutional office or position} or in writing to the applicable contractor or agent contacting me on behalf of Sacred Heart
University. Updating contact information. I understand and agree that I am responsible for keeping Sacred Heart University
records up-to-date with my current physical addresses, e-mail addresses, and phone numbers by following the Office of the
Registrar procedure www.sacredheart.edu/registrar. Upon leaving Sacred Heart University for any reason, it is my responsibility to
provide Sacred Heart University with updated contact information for purposes of continued communication regarding any amounts
that remain due and owing to Sacred Heart University.
4. STUDENT CONSENT AND RELEASE FOR LECTURE CAPTURE: In consideration of the benefits conferred on me through my
participation in courses at Sacred Heart University and for other good and valuable consideration, the receipt of which is hereby
acknowledged, I, the undersigned student, hereby grant to Sacred Heart University and its designees (SHU) the non-exclusive,
royalty-free, worldwide, perpetual right, license and permission to use my name, likeness, voice, biographical information, and
image in any and all audio-visual recordings and other media (whether the media is now known or hereafter developed) produced
by or on behalf of SHU (the Media), solely for educational purposes. I acknowledge and agree that: I will not receive any
compensation of any kind related to this consent and release; I waive any right to inspect or approve the Media; SHU may use the
Media in any manner, including without limitation, reproducing the Media or creating derivative works of the Media; I waive any right,
title and interest that I may have in the Media; I will view the Media solely for my own educational purposes in connection with the
above-identified course; I will not make any other uses of the Media, including without limitation, reproducing or distributing the
Media, or providing others with access to the Media; and, only to the extent permitted by applicable laws, rules and regulations, I
release SHU and its personnel from all liability arising from or related to the Media, and this consent and release.
5. ENTIRE AGREEMENT: This agreement supersedes all prior understandings, representations, negotiations, and correspondence
between me and Sacred Heart University, constitutes the entire agreement between the parties with respect to the matters
described, and shall not be modified or affected by any course of dealing or course of performance. This agreement may be
modified by Sacred Heart University if the modification is signed by me. Any modification is specifically limited to those policies
and/or terms addressed in the modification.
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