Payment and Waiver Form
Yoga Teacher Training
Registration is a 2 part process:
1 Fill out and submit the below Application.
2 Fill out and submit the Payment and Waiver form.
Payment and Waiver Form
Mail check Payable to: Ken Heptig
Mail Check to:
2519 Tower Ct.
Charlotte, NC 29209
Credit Card: Visit Teacher-Training-200-hr. Fall.2014 Re
(Receipt will show as IT Circus LLC, the parent company of GoalYoga Yoga Teacher Training.)
All tuition fees must be paid in a timely manner in accordance with the deadlines specified:
- Relevant application fee to reserve your spot.
- Remaining amount due Sept. 1, 2014 or payment plan authorized by GoalYoga™ with email confirmation.
- Refunds are generally not available but may be considered for extreme circumstances. GoalYoga™ reserves the right to amend this policy at its sole discretion.
Waiver of Liability
I agree to take full responsibility for not exceeding my limits in yoga teacher training or other yoga training and for any injury of discomfort I may experience as a result of practice. I accept that it is my responsibility to ascertain if there are any medical reasons why I should not practice Yoga or other types of movement. I understand that I may injure myself during practice and hereby waive any and all claim I might have at any time for injuries of any sort against GoalYoga, IT Circus LLC, Ken Heptig, Dowd YMCA, other YMCA organizations or any teachers during the training. I, my legal heirs or representatives forever release, waive, discharge and covenant not to sue the above mentioned parties for any injury or death caused by negligence or other acts. I have read and fully understand the above.
I hereby represent and warrant that either:
- I am at least eighteen (18) years of age and am competent in all ways to sign this Agreement and I realize that this is a legally enforceable and binding document. By clicking the box below I certify that I have read and understood every part of this Agreement and I agree to comply with all of its terms and conditions; OR
- I am the parent / legal guardian of the applicant (the Applicant). I understand that I assume full responsibility for the Applicant while he or she is participating in the Teaching Program. By clicking the box below I certify that I have read and understood every part of this Agreement and I agree to the terms and conditions thereto on behalf of and for the Participant. I represent and warrant that I am competent in all ways to sign this Agreement and I realize that this is a legally enforceable and binding document.
- Students must make up hours missed in the program. This may result in more hours of apprenticeship, private lessons or attendance in coursework that is compatible with the hours missed. Certificate of completion are issued when all course work is complete.
- I hereby give my consent for GoalYoga to use my photograph, testimonials, essays, and likeness in all forms of media for advertising and any other lawful purposes. And I understand that I will not record any part of the training with video or audio devices without written permission from GoalYoga.
I am the individual given below. I confirm that all information provided herein is true, accurate and up to date. Further, I agree that to the extent that there are any changes to the information provided above that may affect my ability to attend the Teacher Training, I shall inform GoalYoga™ as soon as possible hereof. I understand and agree that any and all information I submit via this Online Application Form will be sent to GoalYoga™ and myself for the purposes of registration and application for the training in question. In addition, I confirm that I have read, understood and agreed to the payment and refund terms.
By checking this box I hereby declare and affirm the above statement. Checking this box shall serve as my signature.