Registration Form (Yoga Therapy for Special Needs)

Personal Info

Course Location (required)

Course Date (required)

First Name (required)

Last Name (required)

Middle Name

Address Line 1

Address Line 2

City

State

Post Code

Best Contact Number (required)

Alternate Contact Number

Your Email (required)

Professional History

Current Profession

How Long Have you been practising Yoga?

How long have you been a Yoga Instructor ?

Yoga Background (school, style, affiliations, etc.)

Yoga Teacher Training Courses or Certifications Completed.

Do you have experience in working with children ?
 yes no

Why do you want to participate in the Zenergy Kids Teacher Training Course ? or
What do you want to accomplish?

How did you hear about the Zenergy Teacher Training Courses ?

Please describe any physical conditions or imbalances you have that we should be aware of or that could be aggravated by exercise (back or knee problems, heart condition, recent surgery, injuries, high blood pressure, etc.)

Emergency Contact

Name

Phone

 Agree to Terms

Cancellation Policy:

Deposits are refundable for up to 10 days after your registration, after which time they are no longer refundable and only transferable to another course. Course transfers must be completed within one year of the original course date. Any deposits made on or after the balance due date are non-refundable and only transferable. All Refunds or transfers will incur a $50 processing fee. Course registrations are not transferable to a different course or another person. No refunds or transfers will be issued within 30 days of the training. Refunds and transfers may be provided, at our full discretion, where the cause of cancellation is outside of the course participant’s control, such as due to a medical emergency.