Registration Form - Yoga for the Special Child 95H Certification Program - Part 1 - Online Program May 25-29/ June 01-04
Please fill in all fields
I have already registered for a Part 1 Program in (check below) and I want to transfer my registration to this online program *
Required
First Name *
Your answer
Last Name *
Your answer
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!
Your answer
Email
Your answer
I am aware this is a live streaming program and I will organize my schedule to be available at dates and times of training. Week 1 and 2: 9:00 am- 11:30 am and 2:00-4:30 pm. *
I am aware of the dates for the program from May 25-29 and June 01-04, 2020 *
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. *
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
Mailing Address *
Please include: Full address, city & zip
Your answer
Country *
Your answer
Phone *
Your answer
Mobile Phone *
Your answer
Do you have WhatsApp?(please add above mobile number with WhatsApp. *
Emergency contact
Please fill in name & number of contact
Your answer
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)
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
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy