Somatically Minded Holistic Wellness: Virtual Introduction to the Dart Procedures 11/7/20 Registration Form
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First Name *
Last Name *
Date of Birth *
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Gender Identity *
Pronouns *
Emergency Contact Name, Relationship, and Phone Number *
Are there any injuries or health concerns the teacher should be aware of? *
Mailing Address *
Phone Number *
Is okay to contact you about future classes and workshops offered by Somatically Minded Holistic Wellness? *
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What amount on the sliding scale of $5-$25 can you pay and what method will you be using? Venmo is preferred @Sara-Yanney or PayPal sarayc.syc@gmail.com. If you are unable to pay anything right now, we still want you to come. *
Liability Release: By attending this workshop, I acknowledge that Somatically Minded Holistic Wellness is not responsible for any injuries or illness that may occur from my attendance of this workshop or from practicing anything from this workshop on my own in the future. Please initial below. *
Photo/Video Release: I agree to allow Somatically Minded Holistic Wellness to use my image in photo, screen shot, or video to be used for promotional purposes for future workshops and classes. I understand my name will not be used. *
I understand that taking this workshop does not qualify me to teach the Dart Procedures or the Alexander Technique. I understand that in order to teach the Alexander Technique as a certified AmSAT teacher, I must complete a 1600 hour training course. Please initial below. *
By typing my name below, I am acknowledging that I have read through this entire form and I understand all of the content. *
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