Explore Your Creative Potential

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Explore Your Creative Potential

Hatha Yoga Teacher Training, RYT-200 January to October 2016

Name:______Date:______

Address:______

City:______State:______Zip:______

Phone/Day:______Evening/Cell:______

Email:______Birth Date:______

Emergency Contact:______

Number:______Relation:______

How did you hear about us?______

Class Schedule: Please advise us as soon as possible of any days you will be unable to attend the training. In the event of a scheduling conflict or missed class, students may be permitted to do a limited amount of make-up work. All classes are held at Lighthouse Yoga Center at the following times:

 Fridays, 6:00 to 9:00 pm  Saturdays and Sundays, 1-7 pm  One of these weekends will be an out of town retreat. The date will be designated prior to the start of the training.

Dates: January 29-31 February 26-28 April 1-3 April 29-May 1 June 3-5 July 8-10 August 12-14 September 16-18 October 14-16 November 11-13 Course Costs: A $500 non-refundable and non-transferable deposit is required to hold your space.

Early payment discount: pay in full by December 31, 2015 and cost is $2975. Register after December 31 and pay in full: $3200

The total price of the course includes the deposit as well as the full cost of the retreat, excluding transportation. When you register, we ask that you indicate your preferred payment option. Please note that we request payment by check or money order. Credit charges will incur a small surcharge.

Payment Plan Option A: $500 deposit at application -$475 due January 29 Payment plan Option B: -$475 due February 26 $500 deposit at application -$475 due April 1 -$700 due January 29 -$475 due June 3 -$700 due February 26 -$475 due July 8 -$700 due April 1 -$475 due August 12 -$700 due June 3 Total: $3350 Total: $3300

Refund Policy: There are no refunds/credits once the course begins.

Waiver of Liability: I understand that yoga includes physical activity and movement. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will adjust the posture, ask for support from the teacher, and discontinue practice. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga and/or specific poses are not recommended and are not safe under certain medical conditions (e.g., cardiac illness, post-surgery, etc.). The student assumes the risk of their yoga practice and releases the teachers and studio from any liability claims. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to release and waive any claims that I have now or hereafter may have against Lighthouse Yoga Center and its principals and employees.

I also acknowledge that I understand the refund policy for the Lighthouse Yoga Center Teacher Training Program and agree with the terms. Lighthouse Yoga Center reserves the right to withhold your certificate, without a refund, for lack of participation and attendance. I fully accept all of the above terms.

Signature______

Date______

Please return this registration form along with the questionnaire in person or by mail to:

Lighthouse Yoga Center

4203 Ninth Street NW

Washington DC 20011

202-541-9642

[email protected] Application Questionnaire

1. Please tell us about your yoga background and experience.

2. What is it that you most enjoy about yoga?

3. What challenges you most in your practice?

4. Where do you currently practice yoga? What styles and with whom?

5. What motivates you to join in Lighthouse Yoga Center’s teacher training program?

6. Tell us about any teaching experience you have had.

7. Do you anticipate any times that you will not be able to participate in the scheduled training dates?

8. Any injuries or health conditions we should know about?

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