Where did you hear about our program? *

If you heard from a program coordinator or other, please tell us the name of coordinator or where you learned about the training.

First Name *

Last Name *

Type your full name EXACTLY how you want it to appear on the Certificate/Credit Hours (whichever applies) *

Email

I am aware this is a live streaming program and I will organize my schedule to be available at dates and times of training from 08:00-11:30am and 01:00-04:00pm (EST) *

I am aware of the dates for the program from February 05-07, 2021 *

By registering for this program I agree not to copy materials, record or share videos, photos or any links that are shared with me by Yoga For The Special Child®, LLC. I understand that these are copyrighted materials and are shared with me as a registered program participant at the sole discretion of Yoga For The Special Child. Please sign your name below to acknowledge that you will NOT share the materials. *

Birth Date *

Occupation *

Gender *

Hatha Yoga Level *

Do you have a child that is physically challenged? *

Mailing Address *

Country *

Phone *

Emergency contact *

Have you ever attended our Yoga for the Special Child Part 1 Program before? (if so, please write city, state, date and name of teacher you took the training from) *

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.

Please list any prescription medications