Registration Form - Intermediate Hatha TT - Part 1 April 03-16, 2021 - Part 2

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Registration Form - Intermediate Hatha TT - Part 1 April 03-16, 2021 - Part 2 - April 17-30, 2021- Online Via Zoom

Please fill in all fields

Where did you hear about our program? *

Facebook

Instagram

Website

A program coordinator

Other:

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 live streaming program and I will organize my schedule to be available at dates and times of training from Monday/ Wednesday/ Friday – 08:00-11:30am (EST)Saturday and Sunday – 08:00-11:30am/ 01:00-04:00pm (EST) *

Yes

I am aware of the dates for the program from April 03-30, 2021 *

Yes

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 *

Hatha Yoga Level *

Beginner

Intermediate

Advanced

Do you have a child that is physically challenged? *

Yes/No (if yes, please explain below)

Mailing Address *

Please include: Full mailing address, city ,state, & zip

Country *

Phone *

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: Full course, Part 1 or Part 2 *

Are you a 200H Certified Yoga Teacher? When and where have you taken this course? *

YYYY

Payment *

Check

Paypal

Money order

Payment amount *

Check $1000 - Part 1 (Zelle or check)

Paypal $1080 - Part 1

Wire Transfer $1020 - Part 1

I'm a licensed practitioner and want to take advantage of my discount (week 1)

Check $1000 - Part 2 (Zelle or check)

Paypal $1080 - Part 2

Wire transfer $1020 - Part 2

I'm a licensed practitioner and want to take advantage of my discount - Part 2

Part 1 AND Part 2 - $1800 Check (Zelle or Check)

Part 1 AND Part 2 - $1945 PayPal

Part 1 AND Part 2 - $1836 Wire Transfer

I'm a licensed practitioner and want to take advantage of my discount - Part 1 AND Part 2

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 (for part 1 and/or part 2) or a minimum deposit of $300 ($600 BOTH PARTS) . Payment in full must be received 30 days prior to 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 232 Hidden Bay Dr #503 Osprey Fl 34229. You may also ZELLE the money to 941-320-9290. Or request and invoice to wire the money to yscinfo@gmail.com (Dana Rubin).

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 make sure to call Renata 941-320-9290 to confirm the program is a go before making any travel arrangements.

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($600 for 2 weeks) 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 *

YYYY

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