特殊兒童瑜珈 (一階)報名表 - 台灣 2019
請問您之前是否有上過特殊兒童瑜珈的課程? Have you attended a Yoga for the Special Child *
若是有,請提供地點與上課時間 If you have attended, please state where & when
Your answer
緊急聯絡人/Emergency contact *
請留下全名/電話 Please fill in name & number of contact
Your answer
國家/Country *
Your answer
我希望在哪裡上培訓課程 I wish to attend the program in *
please state, city/country
請問您的孩子是帶著身心障慢飛天使的孩子嗎? Do you have a child that is physically challenged? *
是/否 (若"是請提供孩子的狀況) ""Yes/No (if yes, please explain below)
Your answer
性別/Gender *
請問您如何得知特殊兒童瑜珈課程?Please tell us how you hear about the program.
Your answer
我希望在何時上培訓課程 I wish to attend the program commencing *
please fill in date
Email *
Your answer
Registration Form - Yoga for the Special Child Basic Part 1 Program - Taiwan 2019
姓名/Name *
Your answer
連絡電話/Phone *
Your answer
職業/Occupation *
Your answer
瑜珈基礎/Hatha Yoga Level *
住址/Address *
Please include: Full address, city & zip 請填寫完整的住址與郵遞區號
Your answer
生日(年月日)/Birth Date *
Your answer
課程地點
Aditi Yoga Studio
台北市松山區南京東路四段51號7樓

FB: https://www.facebook.com/AditiYogaStudio/

課程費用與方案 (名額有限) *
銀行轉帳帳號
國泰世華銀行 銀行代碼013 帳號 265-50-604217-1 戶名:蕭安淇
付款方式/Payment (請提供銀行帳戶後5碼)
Your answer
是否有服用任何藥物?請提供藥物名稱。Please list any prescription medications *
Your answer
是否有需要安排住宿? Do you need help on arranging accommodation? *
本師資學習過程可能會讓某些學員喚起內心最深層的自己,引發一些情緒上的起伏。 這過程可能會造成學員短暫情緒上的衝擊與負擔,但是這感受是療癒自我的過程。 假如您過去有過精神上疾病的,如抑鬱症,焦慮症,精神分裂症,躁鬱症,創傷後心理壓力緊張症候群,或任何精神上的症狀,請事前告知老師及主辦單位以便老師及主辦單位能夠避免一些不必要的刺激與傷害。 倘若您有在服用任何藥物或曾經因精神疾病入院觀察,請麻煩在下方提供我們相關資訊。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
若需要住宿安排,您希望房型? (選房型有優先順序,主辦單位不能確保房型與房價) If yes, what type of room you want? (base on first come first serve) Service apartment rate may vary depend on the season and length of staying. *
條款和條件/Terms and Conditions
1. 為確認您的上課資格可選擇 一次付金 或 以上付款方式。本次師資課程為保持教學品質有限定人數,會以報名和收到並預付訂金或學費日期後為標準。 主辦單位會通知是否報名成功。

2. 所有的學費款項是無法退費的,除非是 Yoga For The Special Child (YSC) 與主辦單位取消課程,學員才能拿回所有的學費。 但是 Yoga For The Special Child (YSC)與主辦單位並不會負責學員的交通與住宿費用。

3. 若是已報名者在開課10天前因個人因素通知取消課程, Yoga For The Special Child (YSC)與主辦單位會先扣除$3000新台幣的手續費, 剩餘的學費可在取消當天(往後推算1年內) 報其他 Yoga For The Special Child (YSC)的課程。若是一年內沒有使用餘額,這剩餘的錢將永不退還。

4. 若是已報名者在開課10天內因個人因素通知取消課程, Yoga For The Special Child (YSC)與主辦單位會先扣除$10000新台幣的手續費, 剩餘的學費可在取消當天(往後推算1年內) 報其他 Yoga For The Special Child (YSC)的課程。若是一年內沒有使用餘額,這剩餘的錢將永不退還。

5. 請在下面簽名處簽名,
我已詳細閱讀,瞭解並同意指申請書的條款與條件。

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. Money orders should be made payable to Yoga for the Special Child(please email renata@specialyoga.com for Bank details). Mail your payment and application to us at the above address. If you have a credit or debit card please request a paypal invoice.

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.

中文全名 (姓/名) 正楷 / Chinese full name
Your answer
英文全名 (證照名字) English full name (for certification use)
Your answer
日期/Date *
MM
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DD
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YYYY
申請人簽名/Full Name *
Your answer
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