CPD The Golden Keys of Yoga for the Special Child  - January 21-22 / 28-29
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Email *
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) *
We will copy and paste from here, so please write capitals and lower case letters the way you want it to be printed on credit hours. Please be diligent here!  Thanks!
I am aware this is a live streaming program and I will organize my schedule to be available at dates and times of training :Saturday 08:00am-11:00 am and 01:00 pm-04:30pm (EST) Sunday 08:00am-11:00am and 01:00pm-4:00pm (EST) *
I am aware of the dates for the program are January 21, 22, 28, 29, 2023 *
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? *
Yes/No  (if yes, please explain below)
Mailing Address *
Please include: Full address, city, state & zip
Country *
Phone *
Emergency contact *
Please fill in name & number of 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 (if you are a YSC licensed practitioner, please email Maria  info@specialyoga.com, so she can send you the special discount code BEFORE making any payments) *
I am Licensed Practitioner with Yoga for the Special Child ( I will contact Maria  info@specialyoga.com to receive invoice).  Please let her know if you plan to pay by wire, PayPal or check/Zelle.
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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
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