Registration Form - Yoga for the Special Child Basic Program - 2018
Please fill in all fields
Name *
Your answer
Birth Date *
Your answer
Occupation *
Your answer
Gender *
Hatha Yoga Level *
Do you have a child that is physically challenged? *
Yes/No (if yes, please explain below)
Your answer
Would you be interested on having you child evaluated during the program? (we have a session with kids on days 3,4 or 5 at 3pm) *
Yes/No (if yes, please explain below)
Your answer
Address *
Please include: Full address, city & zip
Your answer
Country *
Your answer
Phone *
Your answer
Email *
Your answer
Emergency contact *
Please fill in name & number of contact
Your answer
Have you attended a Yoga for the Special Child program before? *
If you have attended, please state where & when
Your answer
I wish to attend the program in *
please state, city/country
Your answer
I wish to attend the program commencing *
please fill in date
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Current Total Payment
Your answer
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
Your answer
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 and money orders should be made payable to The Yoga Center Reno. Mail your payment and application to us at 720 Tahoe St # C, Reno, NV 89509. If you have a credit card and wish to confirm your reservation by phone, please call (775) 322-4600.

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 $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.

Full Name *
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Date *
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