Registration Form - Yoga for the Special Child 95H Certification Program Part 1 Reno, NV June 14-19, 2020
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First name *
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Last name *
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Name EXACTLY how you want it to appear on Certificate/Credit Hours (whichever applies) *
We will copy and paste from here, so please write caps and lower cases the way you want it to show up on credit hours.
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Birth Date *
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Occupation *
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Gender
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Hatha Yoga Level *
Do you have a child that is challenged? *
Yes/No (if yes, please explain below)
Your answer
Would you be interested on having your child volunteer during the program? Your child will be evaluated and have a personally designed yoga program (we have a session with kids on days 3, 4 and 5 at 3pm) *
Yes/No (if yes, please explain below)
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Address *
Please include: Full address, city, state & 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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Have you attended a Yoga for the Special Child program before? If so, when and where? *
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Current Total Payment
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Payment-see below for payment info *
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 of $300. Payment in full must be received 30 days prior to program start date. Checks should be made payable to Kathy Randolph. Mail your payment to Kathy Randolph, 50 Cliff View Drive, Reno, NV 89523. For credit card payment please request a PayPal invoice from Kathy Randolph, phone/text (775) 322-4600, e-mail kathy@yogaforscleroderma.com. For local transportation, lodging, etc. go to http://theyogacenterreno.com/teacher-trainings/basic-1-registration-letter-reno-2020/

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 $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 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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