Yoga Child Teacher Training Registration Form

Childrens' Teacher Training 2008

Please print and mail this form with payment to :

Yoga Child, inc., PO Box 63730, Philadelphia PA 19147

 

1. Last Name:

    First Name:

2. Full Adress:

3. Phone number:

4. Email Address:

5. Personal Backround: (please include any yoga experience or certifications, any experience you have working with children, or any professional degrees)

 

 

 

 

6. Are you a parent? If so what are the ages of your children?

 

7. Select your program by circling one of the options below:

   1. Philadelphia area trainee; core training plus field study: $1200

   2. Out of state Trainee (Select from the options below)

        a. Yogi on your way: $900

        b. Yoga Child Affiliate: $1575 ( please identify your home state__________________________________)

        c. School Teacher on your way: $800

        d. School Teacher Affiliate: $1375 (please include your home state here____________________________)

        e. School or Facility Admistrator: $600 per student. You may complete one application for all staff that you are sending. Please use your name, position and your school name and address for the contact information and attach a list of names of the staff who will be attending.

                      i. Please include the number of  teachers you are enrolling. #_______

                     ii. I have attached a list with the names of our staff members who will be attending.

8. Select your method of Payment:

       a. Credit Card:  Visa    or   Mastercard

                     i. My Credit card number is:

                    ii. The Expiration Date on my card is:

  

      Fifty percent of the program fee will be charged to your card upon receipt of your registration form and that the remaining 50% will be charged 30-45 days prior to the start of the training unless you specify that you would like the entire program fee charged upon receipt of the application.

      b. I am paying by Check

                   i.Enclosed is a check for the full amount of my program fee.

                  ii.Enclosed is a check for 50% of the program fee. I will mail in the balance by May 10, 2007.

9. Refund Policy: As stated on our website.