Registration Form - Yoga for the Special Child 95H Certification Progra Part 2 - België, 14-20 March, 2020
Please fill in all fields
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First Name *
Last Name *
Name EXACTLY how you want it to appear on Certificate/Credit Hours (whichever applies) *
We will copy and paste from here, so please write caps and lower cases the way you want it to show up on credit hours.
Birth Date *
Occupation *
Gender *
Hatha Yoga Level *
VIDEO CLASS *
An important part of this training is having the opportunity to observe participants working with kids with special needs while receiving feedback from Sonia.  In preparation for the Part 2 course you have been asked to complete four half-hour yoga sessions with kids with special needs.  Please bring a recording of one of those sessions with you to the training. In order to ensure diversity among the videos participants bring we hope to work with you, to select what session you record.  Please share your preference by writing 1 for first choice, 2 for second and 3 for third.
Group Age *
An important part of this training is having the opportunity to observe participants working with kids with special needs while receiving feedback from Sonia.  In preparation for the Part 2 course you have been asked to complete four half-hour yoga sessions with kids with special needs.  Please bring a recording of one of those sessions with you to the training. In order to ensure diversity among the videos participants bring we hope to work with you, to select what session you record.  Please share your preference by writing 1 for first choice, 2 for second and 3 for third.
Have you attended a Yoga for the Special Child program before? When and where? *
If you have attended, please state where & when
Do you have a child that is physically challenged? *
Yes/No  (if yes, please explain below)
Mailing Address *
Please include: Full address, city & zip
Country *
Phone *
Email *
Emergency contact *
Please fill in name & number of contact
I wish to attend the program in *
Brugge, Belgium
I wish to attend the program commencing *
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Program Location: Brugge *
Payment *
(If you are a licensed practitioner, we will give you the discount accordingly for this program. Just let us know. )
Required
The teacher training experience can be a time of deep emotional connection for some people. Though this process is healing, it can also be stressful. If you have any history of mental illness i.e. depression, anxiety, schizophrenia, bipolar disorder, posttraumatic stress disorder or any form of psychosis, it would be very helpful for your teacher to know in order to be sensitive to your needs. If you are taking medications or have been hospitalized for any of these conditions please describe below.
Please list any prescription medications
Terms and Conditions
 1. To confirm your reservation, please make full payment or a minimum deposit of €300. Payment in full must be received 30 days prior to program start date. Payments can be by Paypal or wire transfer. If you need an invoice to do a wire transfer (for example, your company will pay for your training), please send an email to Renata Sumar Gaertner at renata@specialyoga.com. Add details to speed up the process (name of payer, address, email, name of person taking the course and any other detail needed on invoice. Please email renata@specialyoga.com or text 1-941-320-9290, if you don't receive an invoice for us within 2 days after you sign up.

2. All payments made are non-refundable, unless the program is canceled by Yoga For The Special Child (YSC), in which event you will receive a full refund. However YSC shall not be responsible for refunding airline tickets or hotels under any circumstances.  

3. If registrant cancels 10 or more days before the program start date, by way of YSC receiving notice from registrant within that time, the sum of €100 shall be deducted by YSC as an expense of administration.  Any balance paid in excess of €100 shall be held for registrant without interest, and may be applied by registrant to another program within one year of cancellation.  If not applied within one year, all monies paid shall be forfeited.  

4. If registrant cancels less than 10 days before the program start date,  the sum of €300 shall be deducted by YSC as an expense of administration.  Any balance paid in excess of €300 shall be held by YSC without interest, and may be applied by registrant to another program within one year of cancellation.  If not applied within one year, all monies paid shall be forfeited.

5. By signing below, I, the registrant, agree to these terms and conditions.    
Full Name *
Date *
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