Registration Form - Yoga for the Special Child Continuing Education Program - FL - 2019
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Name *
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Birth Date *
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Occupation *
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Gender *
Address *
Please include: Full address, city & zip
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Country *
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Phone *
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Email *
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Emergency contact *
Please fill in name & number of contact
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Hatha Yoga Level *
Where and when did you attend Basic Part 1 Program? *
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Have you attended Basic Part 2 or a CPD Program with us? *
yes/no please tell date and location below if yes.
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I wish to attend the program in *
please state, city/country
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I wish to attend to program *
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I want to pay for *
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Payment *
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. *
Your answer
Please list any prescription medications
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Terms and Conditions
1. To confirm your reservation, please make full payment or a minimum deposit. Payment in full must be received 30 days prior to program start date. Checks and money orders should be made payable to Yoga for the Special Child. Mail your payment and application to us at the above address. If you have a credit card and wish to confirm your reservation by phone, please email renata@specialyoga.com and ask for a paypal invoice or use the links on our website.

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 do not make travel arrangements until you have received a program confirmation letter from the YSC office.

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 per program as an expense of administration. Any balance paid in excess of $80 per program 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 $250 per program shall be deducted by YSC as an expense of administration. Any balance paid in excess of $250 per program 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.

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