CPD Asana Choreography: the Art of Sequencing with Renata MahaJyoti and Shanthi Erin - November 11-12, Chicago - IL HYBRID
Please fill in all fields that applies to you
Sign in to Google to save your progress. Learn more
Email *
Where did you hear about our program? *
Required
If you heard from a program coordinator or other, please tell us the name of coordinator or where you learned about the training.  
First Name *
Last Name *
Type your full name EXACTLY how you want it to appear on the Certificate/Credit Hours (whichever applies) *
We will copy and paste from here, so please write capitals and lower case letters the way you want it to be printed on credit hours. Please be diligent here!  Thanks!
Email
I am aware this is a hybrid program, and I will organize my schedule to be available at dates and times of training on  Saturday and Sunday from 08:00 a.m. to 12:00 pm and 1:30 pm to 5:30 pm (Central time) *
I am aware of the dates for the program from November 11 and 12, 2023 *
I plan to attend the program: *
By registering for this program I agree not to copy materials, record or share videos, photos or any links that are shared with me by Yoga For The Special Child®, LLC.  I understand that these are copyrighted materials and are shared with me as a registered program participant at the sole discretion of Yoga For The Special Child. Please sign your name below to acknowledge that you will NOT share the materials. *
Birth Date *
Occupation *
Gender / Pronouns *
Hatha Yoga Level *
Mailing Address *
Please include: Full address, city, state & zip
Country *
Phone *
Emergency contact *
Please fill in name & number of contact
Have you ever attended our Yoga for the Special Child Part 1 Program before? (if so, please write the city, state, date, and name of the teacher you took the training from) *
Payment (sign up by October 01 and receive a special 20% discount using the CODE 20off  - after October 01, the total price will be applied) *
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
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms