Registration Form - Yoga for the Special Child 95H Certification Program - Part 2

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Registration Form - Yoga for the Special Child 95H Certification Program - Part 2 - October 01-07, 2022

Please fill in all fields

First Name *

Last Name *

Birth Date *

Occupation *

Gender / Pronouns *

Hatha Yoga Level *

Beginner

Intermediate

Advanced

VIDEO CLASS *

An important part of this training is having the opportunity to observe participants working with kids with special needs while receiving feedback from Sonia. In preparation for the Part 2 course you have been asked to complete four half-hour yoga sessions with kids with special needs. Please bring a recording of one of those sessions with you to the training. In order to ensure diversity among the videos participants bring we hope to work with you, to select what session you record. Please share your preference by writing 1 for first choice, 2 for second and 3 for third.

Cerebral Palsy

Down Syndrome

Autism Spectrum Disorder

ADD/ADHD

Other:

Group Age *

0-3

3-6

6-12

13-14

14-15

15-16

mixed ages

Other:

Do you have a child with additional or complex needs? Do you yourself have any additional needs or physical disabilities? *

Yes/No (if yes, please explain below)

Mailing Address *

Please include: Full address, city, state & 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 *

please state, city/country

I wish to attend the program commencing

please fill in date

YYYY

Program Location *

Payment *

FLASH SALE (valid until August 31, 2022) £907

Deposit £250

Full payment - £987

I would like to make a wire transfer to Yoga for the Special Child (please email info@specialyoga.com)

Payment on Installments ( pay monthly option - last payment in October 05, 2022 - please contact SriDevi sridevidenisa@gmail.com )

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 or a minimum deposit of £250. Payment in full must be received 10 days prior to program start date. Payments options are bank transfer ( Natwest Bank, UK, Denica Nenova acc. 22799044, sort code 56-00-13) or Paypal (debit or credit card - no need to have an account with Paypal to use this option). If you need an invoice please send an email to Renata Sumar Gaertner at renata@specialyoga.com. Add details to speed up the process (name of payer, address, email, name of person taking the course and any other detail needed on invoice).

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.

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 £80 shall be deducted by YSC as an expense of administration. Any balance paid in excess of £80 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 £200 shall be deducted by YSC as an expense of administration. Any balance paid in excess of £200 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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