Registration Form - 95H Certification Program Yoga for the Special Child Part 1 Training Hybrid Training

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Please fill in all fields - Program Dates: April 19-21 and 26-28, 2024

Friday to Sunday - 9:00 am - 5:00 pm (Friday sessions will be online only)

Name *

Birth Date *

Occupation *

Gender/ pronouns *

Hatha Yoga Level *

Beginner

Intermediate

Advanced

Do you have a child that is physically challenged? *

Yes/No (if yes, please explain below)

Would you be interested on having you child evaluated during the program? (we have a session with kids on days 3,4 or 5 at 3pm) *

Yes/No (if yes, please explain below)

Address *

Please include: Full address, city & zip

Country *

Phone *

Email *

Emergency contact *

Please fill in name & number of contact

Have you attended a Yoga for the Special Child program before? *

If you have attended, please state where & when

I wish to attend the program in Sarasota *

please state, city/country

Online only

In person (I am aware Friday's classes are online)

First weekend in person and second weekend online

First weekend online and second weekend in person

Required

I am aware of the dates and times of the program (EST) Program Dates: April 19-21 and 26-28, 2024

Friday to Sunday - 9:00 am - 5:00 pm (Friday sessions will be online only)

please fill in date.

YES

Payment *

Deposit only (full payment due 30 days prior to beginning of training) $350

Full payment - early bird - pay in FULL by February 20 $880

Full payment - special discount - pay in full by March 31st $980

Full payment - $1080

YSC Licensed Practitioner repeating the course - please email renata@specialyoga.com for discount coupon (35%)

I am a parent of a child with disability (please email renata@specialyoga.com for discount coupon 20%)

Payment - if you want to pay with ZELLE or check, please contact our office (info@specialyoga.com) and let us know. ZELLE number: 941-320-9290 Check : Make it payable to Yoga for the Special Child , 6255 Sturbridge Court Sarasota FL 34238 *

I want to send ZELLE payment

I want to mail a check

I will use the link provided after registration to pay by credit or debit card.

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 (according to the choices above) or a minimum deposit of $350. Payment in full must be received 30 days before the program start date. Please email your name to renata@specialyoga.com if you want a PayPal invoice or mail your check to Yoga for the Special Child, 6255 Sturbridge Court Sarasota, FL34238

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. Please send a WhatsApp message to Renata at 941-320-9290 to confirm the program is a go before making any travel arrangements.

3. If the registrant cancels ten or more days before the program start date, by way of YSC receiving notice from the registrant within that time, YSC shall deduct the sum of $90 as an administration expense. Any balance paid more than $90 shall be held for the registrant without interest and may be applied by the registrant to another program within one year of cancellation. If not used within one year, all monies paid shall be forfeited.

4. If the registrant cancels less than ten days before the program start date, the sum of $300 shall be deducted by YSC as an administration expense. YSC shall hold any balance paid over $300 without interest and may be applied by the registrant to another program within one year of cancellation. If not used 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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