Application - Yoga for Special Child 95-hour Certification, Part 1 (48 hours)

I am aware this is an IN PERSON program with Covid Protocols in place-- this includes proof of vaccination, and agreement to follow requests for masking and social distancing when required. Untitled*

Yes

I am aware this program will take place at Integral Yoga Institute in New York City. The dates for the program are July 10-15, 2022. 9:00 AM - 5:00 PM daily with a one hour break for lunch.*

Yes

Personal Information

Name*

First Preferred Name (Nickname, Spiritual name) Last Prefered Pronouns

Preferred Pronouns*

Email*

Phone*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

My Home and Mailing addresses are the same*

Yes

No

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*

Occupation*

How did you find out about this program? Check all that apply.*

Your Yoga Experience

Hatha Yoga Level*

Beginner

Intermediate

Advanced

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!

Do you have a child that is physically challenged?*

Yes/No (if yes, please explain below)

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)*

Health and Safety Information

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:*

Emergency Contact Information

Emergency Contact Name*

First Last

Emergency Contact Methods*

Phone

Email

Phone & Email

Emergency Contact Phone*

Emergency Contact Email*

Agreements

Copyright Agreement*

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 acknowledge that you will NOT share the materials, or photos and will not do any recordings of the training.

I have read and agree to the copyright policy.

Tuition Policy*

Tuition payment must accompany your application to complete your enrollment.
Full payment is due before the training begins. A deposit of $300 is required to reserve your space in the program
Non-payment of tuition will result in canceled registration from the course.
A non-refundable administrative fee of $100 is included in tuition pricing.

• Early Bird Tuition for applications received by May 10, 2022 is $980.
• Full Price Tuition for applications received after May 10, 2022, is $1080.

Directions to complete registration with your tuition payment will be emailed to you after your application has been reviewed.

I have read and agree to the tuition policy.

Admission and Continuation Policy*

Acceptance into the training program is not guaranteed, and is conditional upon the applicant meeting the basic requirements as stated in the training prerequisites. A completed application form and deposit are required to be considered for acceptance. Tuition must be paid in full before the training begins, or the student may not be admitted to join the class. If an applicant is not accepted into the program, the deposit will be refunded. If the student decides to withdraw their application before the training begins, the deposit fee is nonrefundable. Any balance paid beyond the deposit amount will be returned.

After the training begins, any refund of tuition is contingent upon several factors including but not limited to: length of time in the program, reason for withdrawal or dismissal, return of training materials, intention to complete the training at a later date. Applicants acknowledge that refunds after the training begins are not guaranteed, and will be issued in accordance with the Admission and Continuation Policy as stated.

I agree to the Admission and Continuation Policy

Terms and Conditions

1. To confirm your reservation, please make full payment or a minimum deposit of $300. Payment in full must be received 30 days prior to program start date. The easiest way to submit payment is online via our MindBody registration system, or through Zelle or Paypal. Checks and money orders are also accepted, and should be made payable to Integral Yoga Institute and mailed to Integral Yoga Institute attn: Jayadevi, 227 W. 13th St., New York, NY 10024. (US funds only) If you need an invoice, please send an email to Jayadevi at TeacherTraining@iyiny.org.

2. All payments made are non-refundable, unless the program is canceled by Yoga For The Special Child (YSC) or Integral Yoga Institute, in which event you will receive a full refund. However, YSC and IYI shall not be responsible for refunding airline tickets, hotels, or other travel/accommodation arrangements under any circumstances.

3. If registrant cancels 10 or more days before the program start date, by way of IYI/YSC receiving notice from registrant within that time, the sum of $100 shall be deducted by IYI/YSC as an expense of administration. Any balance paid in excess of $100 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 $300 shall be deducted by IYI/YSC as an expense of administration. Any balance paid in excess of $300 shall be held by IYI/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 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. 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.

6. By signing below, I, the registrant, agree to these terms and conditions.

I agree to the terms of the Terms and Conditions

General Enrollment Agreement

I wish to apply as a Teacher Trainee, and I agree to assume full responsibility for any injuries to me that may occur during the training. I am in good health, and any physical illnesses or ailments are clearly stated above. I have read and agree to abide by the policies for admission and continuation of the training program. I acknowledge agreement to fulfill all my teacher training requirements to meet Integral Yoga Institute and Yoga Alliance standards in order to receive my certification. I further acknowledge that Integral Yoga Institute reserves the right to withhold certification should my efforts not meet its requirements and standards.

I agree to the terms of the General Enrollment Agreement

Payment

Select payment method for application deposit:

Credit or Debit Card

Paypal

Zelle

Check

Deposit

Price:

Credit Card

Card Details

Cardholder Name

After submitting this application send your $300 deposit fee via PayPal to gopala@iyiny.org.
Please include your name and the Training you are applying for with your payment

After submitting this application send your $300 deposit fee via Zelle to gopala@iyiny.org.
Please include your name and the Training you are applying for with your payment

After submitting this application,
- Make check for $300 out to:
Integral Yoga Institute Inc.
- Send To:
ATTN: Treasury
227 West 13th Street.
New York, NY 10011

Application – Yoga for Special Child 95-hour Certification, Part 1 (48 hours)

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Apply now for Yoga for the Special Child 95-Hour Certification Program, Part 1!

Personal Information

Your Yoga Experience

Health and Safety Information

Emergency Contact Information

Agreements

Payment

(212) 929-0585

info@iyiny.org

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