Registration Form - Yoga for the Special Child 95H Certification Program - Part 1 - Online Program March 12-14/19-21/26-28, 2021
Please fill in all fields
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!
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.
I am aware this is a live streaming program and I will organize my schedule to be available at dates and times of training. Fridays 18:00-21:00/ Saturdays and Sundays: 08:30-11:30 and 14:30-17:00 (Central European Time) *
I am aware of the dates for the program from March 12-14/19-21/26-28, 2021. *
By registering for this program I agree not to copy materials, share videos 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/postal code
Country *
Phone *
Mobile Phone *
Do you have WhatsApp?(please add above mobile number with WhatsApp. *
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 *
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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