REGISTRATION Kidding Around Yoga™ Training Registration Form Location and Dates First name Last name Name you would like on your certificate Street Apartment City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Country Phone Cell Phone Email Occupation Birth date Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Emergency contact Name Phone Website Are you a “certified” Yoga instructor? If yes from where? What year were you certified? Do you currently teach Yoga classes? Kids Yoga classes? What interests you most about kids yoga? What is the most important thing for you to learn at this course? Do you have any health issues that we should be aware of? If you are coming from out of town would you be interested in sharing a hotel room? How did you learn about this course? What is your T Shirt Size? You are expected to be at the entire training. If you have any issues with being there in a timely manner please indicate here. I understand the following concerning the KAY Teacher’s Training. All information I hear from participants and especially personal stories about them, their family, students etc. are confidential. I agree to never repeat or put into writing these stories. They are offered only to enrich our training and we must all respect each other in this way. All materials in my manual are for my purposes only. Everything is copyrighted and cannot be used for any purpose other than for me in my classes. I agree to never share my manual with others as I know that it is in the best interest for all concerned to have more people “take” the training. And for KAY to be able to continue to do the work that they do. I am a “Certified KAY teacher” after my 3 day training, and if I choose to I can become a “Certified KAY licensee” for an additional fee. The Logo and KAY name are both registered trademarks of KAY. I will not use them in any advertising unless I am a “Certified Licensee”, or if I have prior written permission. Miscellaneous: I will come prepared with a yoga mat, water, and wearing comfortable clothing and a sweater. I commit to being timely as it is disturbing to the flow of the training to come late or leave early. I will not receive a certificate if I am not in the entire training. Special arrangements can possibly be made afterwards for a fee if I need to make up time in order to receive a certificate. I will come with a REALLY great attitude and will be prepared to do some serious Kidding Around!