Teacher Training - Registration Form - Taylore Carre's Divine Balance

Teacher Training Registration Form

Teacher Training Registration Policies:

Please keep in mind the following information before registering:
- 50% Tuition is required at time of registration. Remaining 50% will be collected 1 week before course start date.
- A registration form is required for each training, the short form is required for the second and additional training.
- For Yamuna Body Rolling courses Part 1 and Part 2 DISCOUNT: $65.00 off each part when payment is received in full 6 weeks prior to course start date.
  *Not for Recertification, Intensive, repeats, or any training taken with Yamuna
- You are not registered unless you receive a registration confirmation email response.
Fees are inclusive of instruction and materials.

Refunds and Cancellation:

Divine Balance Studio cancellation of a class or workshop:
- Your choice of full refund or apply 100% tuition to another class.
- Yamuna studio and Taylore Carre’s Divine Balance are not liable for travel and accommodation expenses.
- Make sure that all of your arrangements are refundable or changeable or both.
Student cancellations:
- 6 weeks or more prior to class: 100% Tuition Refund.
- 2-4 weeks notice prior to class: 50% Tuition Refund.
- 4-14 days notice prior to class: 25% Tuition Refund.
- 3 days or less prior to class: No Refund.
*Cases of extreme emergency will be reviewed on an individual basis.
*All refunds may be applied to another class which must be taken within 1 calendar year of cancelled class.
*Cancellations must be received in writing.
Section A: General Information
Today's Date:*
DD slash MM slash YYYY
Name*
First Middle Last
Date of Birth*
DD slash MM slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Daytime Phone Number
Evening Phone Number
Email
Occupation
Section B: Class & Workshop you are registering for
Course name you are taking:*
This field is hidden when viewing the form
Choose your course option:*
Class Location
Class Date
DD slash MM slash YYYY
Section C: Payment Method
You will pay after submitting this form when you are registering for the specific classes.
Section D: Short Health Questionnaire
Please check all that apply:
- Spinal surgeries/disorders
- Muscle/joint pain
- Muscle/bone injuries
- Sprains/strains
- Cesarians
- High Blood Pressure
- Low Blood Pressure
- Diabetes prosthesis
- Asthma/lung problems
- Pregnancies
Please list dates and details for the items you checked:
Are you currently under a physician's care?
- No
- Yes
If "yes", please explain:
Your physician's name
Are you pregnant now?
- No
- Yes
If "yes", how many weeks are you pregnant currently?
Please list all medications and any supplements you are taking:
Do you have any medical / health conditions which will prevent your full participation in the class / workshop that you are registering for?
- No
- Yes
If "yes", please explain:
Section E: Emergency Contact
Please give the name of a person, either a relative or friend who lives in the United States, who can be contacted in the case of emergency.
Emergency Contact Name
First Last
Daytime Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Section F: Other
Have you ever applied to or attended YBR classes previously?
- No
- Yes
If "yes", please list the date of application or enrollment:
DD slash MM slash YYYY
Have you ever been convicted of a felony or misdemeanor, other than minor traffic offenses?
- No
- Yes
If "yes", please describe:
Modalities you are certified / licensed in and the date you received your certificate / license:
How did you learn about Yamuna Body Rolling?
Agreement of Release and Waiver of Liability
Please read and sign this waiver. Electronic and typed signatures have the same force and effect as manual signatures.
Signature*
Date*
DD slash MM slash YYYY
Printed Name*
Comments
This field is for validation purposes and should be left unchanged.

Teacher Training Registration Form

Teacher Training Registration Policies:

Refunds and Cancellation:

Section A: General Information

Section B: Class & Workshop you are registering for

Section C: Payment Method

Section D: Short Health Questionnaire

Section E: Emergency Contact

Section F: Other

Agreement of Release and Waiver of Liability