GYROKINESIS Cardiovascular Breathing Course Program 1--in Seattle, WA--May 30-June1, 2023 
Teacher Training Course registration 
Conducted by SMT Jane Gotch

At Seattle Changing Room
2110 Westlake Ave N
Seattle, WA 98109
Elaine Shen--owner--contact email: seattlechangingroom@gmail.com

Please note: To complete your registration, please submit your course deposit to MT Jane Gotch, studio fee to hosting studio, Seattle Changing Room, and complete this registration form. Let us know if you have any questions.
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TOTAL COURSE FEES

$550 course fee--paid to Jane Gotch

Studio fee is $210+tax--paid to Seattle Changing Room

follow this link to pay the studio fee:

 https://clients.mindbodyonline.com/classic/ws?studioid=29708&stype=-8&sTG=36&sVT=102&sView=day&sLoc=0&sTrn=100000069

NON-REFUNDABLE DEPOSIT (to Jane Gotch)

$200

Deposit will be returned to the student in full in the event that the course does not run.

I understand that my non-refundable deposit will be applied to the course fee. The course fee balance of $350 is due to Jane, and the studio fee will be paid directly to the studio host. If you decide not to attend the course, your deposit will not be refunded.

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Required
Course deposits may be paid by:

--Venmo to @Jane-Gotch. Without payment protection.

--PayPal to Janegotch (might be listed as Gyrotonic KC Center) Send as Friends and Family only. 
PLEASE NOTE: PayPal is deducting fees from all transfers. $10-20 per transfer. If you choose PayPal, you will need to reimburse me for those fees. I do not recommend using PayPal.

--Zelle to Jane Gotch, Jane.gotch@gmail.com

The registrant will be responsible for covering any processing fees that are deducted from the final payment amount through Venmo or PayPal.

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The course must be completed in entirety to receive credit for the course. If the student wishes to miss a portion of the course, it must be approved by the Master Trainer in advance of the course, and is at her discretion. The missed hours and curriculum will need to be made up privately, in-person at the student's expense.

Missing course days is highly discouraged.

If you are sick or have another emergency which prevents you from attending, please contact the Master Trainer as soon as possible. Do not attend the course if you are sick or have symptoms of illness.
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Required
Name *
Personal Pronouns
Address *
Phone number *
Email *
Studio affiliation (where you offer Gyrotonic services) *
Studio address (if different than above)
Any trauma, injury, accident, or surgery history you would like me to know as the teacher conducting the course. *

GYROTONIC® and GYROKINESIS® Code of Conduct as outlined by GYROTONIC® Headquarters for all Gyrotonic and Gyrokinesis Trainers:

1. Be honest in all professional activities

2. Treat all communication with students/clients with professional confidentiality.

3. Maintain a safe, clean and comfortable teaching environment.

4. Represent yourself honestly with regard to training, experience, and qualifications and refer clients/students to physicians and other professionals as needed and/or indicated.

5. Never attempt to diagnose a student’s physical or psychological condition, prescribe a treatment, or suggest or approve of going against a physician’s advice.

6. Describe yourself as a teacher of movement using the Gyrotonic method and/or Gyrokinesis method and clearly state when you are teaching by this method and when you are not.

7. Inform clients/students as to fees and conditions of work, expected duration, and results.

8. Follow all local, state, and national laws that pertain to teaching the Gyrotonic and/or Gyrokinesis method(s).

The following conduct is unacceptable and will not be tolerated:

1. All forms of bias including race, ethnicity, gender, disability, national origin, religion and creed as demonstrated through verbal and/or written communication and/or physical acts.

2. All forms of sexual suggestion or harassment with clients, students, & other trainers, even when they invite or consent to such behavior involvement. Sexual suggestion is defined as, but not limited to, all forms of overt and covert seductive speech, gestures, and behaviors as well as physical contact of a sexual nature; harassment is defined as, but not limited to, repeated comments, gestures, or physical contact of a sexual nature.

3. All types of proven dishonesty, including cheating, plagiarism, knowingly furnishing false information, forgery, and alteration or use of official documents with intent to defraud.

4. Intentional disruption or obstruction of teaching, administration, or other educational activities.

5. Theft or damage to the property or premises of others.

6. Teaching or attending class while intoxicated, under the influence of a controlled substance, or in any other state that would result in impaired judgment.

Scope of Practice

The Gyrotonic and Gyrokinesis methods are not massage techniques, bodywork techniques, or medical practices. They are exercise practices that can have therapeutic benefits and may function as a compliment to medical care. Gyrotonic and Gyrokinesis Trainers do not provide medical diagnoses, nor do they prescribe, or provide medical treatment.

In addition to demonstration and verbal cues, Gyrotonic Trainers provide supportive, non-corrective touch to provide movement awareness.

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Required

INFORMED CONSENT FOR WORK AGREEMENT

I, the undersigned have registered in a program of physical activity offered by Resilient Body GYROTONIC® and Jane Gotch (Practitioner) that is based in the GYROTONIC EXPANSION SYSTEM®.

I hereby represent and warrant that I do not currently suffer from, and that I have not been diagnosed with any illness, disorder or condition, either physical or mental, that may make it unadvisable, for any reason, for me to either participate in the GYROTONIC EXPANSION SYSTEM®, or to assume all risks associated with this system. I have disclosed, verbally or in writing, any injuries or concerns I may have that may reasonably be expected to impact, or to be impacted by, including but not limited to physical, mental or emotional injuries or concerns. I understand that nothing said or done at Resilient Body GYROTONIC® or by Jane Gotch is a substitute for a medical examination or diagnosis. It is my responsibility to consult with my doctor or other health care provider before I undertake in any aspect of this system.

I fully understand that the purpose of all services offered at Resilient Body GYROTONIC® and by Jane Gotch is to balance and align the physical body. This is done through movement activities, direct hands on manipulation and education, so that a greater economy and freedom of body movement are achieved. I give the Practitioner full privilege and license to work on my body in order to assist me achieve this.

I understand there is a risk of accident or injury from my participation. I agree to take full responsibility for, and expressly assume all risks of my participating with the GYROTONIC EXPANSION SYSTEM®, and herby agree to fully and completely hold harmless, indemnify and irrevocably release Resilient Body GYROTONIC® and Jane Gotch, and each of its practitioners, employees, trainer or contractors, each of their respective heirs, successors and assigns, from all liability for any illness, injury, stress or condition (physical or mental) or other loss or damage of any type whatsoever in law or in equity, that may occur at any time in connection with Resilient Body GYROTONIC® and/or Jane Gotch, even if arising from negligence, to the fullest extent permitted by law. I agree that I will not hold any of the above liable for any information received or results experienced through my participation.

This Informed Consent shall be governed by an interpreted in accordance with the laws of the State and country in which the course is held. I herby agree that in the event of any provisions of this Consent is deemed invalid, ineffective or unenforceable, the enforceability of the remaining provisions of the Consent shall not be affected. This Consent contains our entire agreement.

I hereby affirm that I have read and fully understand this Informed Consent, and by my signature below I agree to all terms thereof.

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Required
I give permission for photographs/videos may be taken by the instructor or hosting studio during the training course and used for marketing purposes.
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Required
Please type your full name below as your signature of consent and agreement. Thank you *
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