Yoga for the Special Child®
Yoga for the Special Child®
Toll Free Number 1-888-900-YOGA
4812 Benchmark Ct. , Sarasota , FL 34238
Telephone: (941) 925-9677 Fax: (941) 925-9433
E-Mail: Info@specialyoga.com Web: www.specialyoga.com
* Contact for Reno Programs at The Yoga Center : Telephone (775) 881-7848 *
E-mail: Kathy@theyogacenterreno.com
Yoga For The Special Child Program Registration Form
RENO PROGRAMS 2012
Name ______________________________________________________ M [ ] F [ ]
Birth date _________ Occupation ______________________________________
Hatha Yoga Level: beginner [ ] intermediate [ ] advanced [ ]
Is your child physically challenged? _____ (If yes, please describe on separate page.)
Address __________________________________________________________
City _________________________________ State ________ Zip _____________
Phone (home) ____________________ (Work) ___________________________
E-mail ___________________________________________________________
Emergency Contact Name __________________________Phone_____________
Emergency Email Address ____________________________________________
How did you first hear about Yoga for the Special Child?
________________________________________________________________
I wish to attend the ____________________________ program at Reno , Nevada
I wish to attend the program beginning: (Month) ___________ (day) ___________
Current Total Payment: $ ____________________________________________
[ ] Check [ ] Visa [ ] MasterCard
Account Number ___________________________________________________
Expiration Date __________________ V-Code (3 digit# on back of card)________
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, post-traumatic 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:________________________________
_________________________________________________________________
_________________________________________________________________
Terms and Conditions:
1) To confirm your reservation, please make full payment or a minimum deposit of $250. Payment in full must be received 30 days prior to program start date. Checks should be made payable to The Yoga Center. If you pay by Visa or MasterCard, the charge will show as The Yoga Center.
Mail your payment and application to:
The Yoga Center
720 Tahoe Street , #C
Reno , NV 89509
If you are paying by Visa or MasterCard, you may e-mail your application to:
kathy@theyogacenterreno.com .
2) All payments made are non-refundable, unless the program is cancelled 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 $50 shall be deducted by YSC as an expense of administration. Any balance paid in excess of $50 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 $250 shall be deduction by YSC as an expense of administration. Any balance paid in excess of $250 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.
Signature:_______________________________________Date:________________