Sandbox Student InformationName* First Last Social Security Number*Date of Birth* Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* I prefer to be contacted by:*EmailPhoneEmergency ContactEmergency Contact Name* First Last Phone*Relationship*Program InformationHow did you learn about Yoga Sanctuary's Teacher Training Program?(please check all that apply) I practice at Yoga Sanctuary (formerly Surya Rakta Wellness) Internet Search Yoga teacher recommendation Advertisement A friend What teacher may we thank for recommending you?Where did you see the advertisement?Which friend we thank for referring you?About YouHow many years have you been practicing yoga?*How many days per week do you average of personal yoga practice?*At which yoga studio(s) do you currently practice?*What styles of yoga do you practice, prefer, or have you explored?*Who have been your primary yoga teachers/mentors?*Are you currently teaching yoga?* Yes No How many years have you been teaching?Where do you teach?What style(s) do you teach?What interests you in Yoga Sanctuary's Yoga Teacher Training Program? What draws you to teach yoga?*What are your expectations for this training? What do you hope to achieve at the completion of the program?*Lastly, is there anything else that you would like to share about this journey, your motivation, your expectations, or your experience?Medical HistoryHow would you evaluate your current health?*ExcellentGoodFairDo you suffer from any of the conditions below?* Epilepsy Diabetes Hypertension/Hypotension None of these Are you currently pregnant or do you plan to become pregnant during the course of training?*select onecurrently pregnantplan to become pregnant during the trainingneitherAre you currently or during the past two years have you been under the care of a physician or mental health care professional?*YesNoPlease explain:*Please list any medications you are currently taking:Do you have any pre-existing injuries that may affect your ability to participate in this course?*YesNoPlease explain:*Please list any other medical issues that could affect your yoga practice:TuitionEither payment in full or initial deposit and a signed payment plan must be received before the first class. Students may pay for tuition and fees with cash, cashier’s check, debit card or credit card. All financial obligations to the school must be satisfied in order to receive a certificate of completion. The total cost for the Yoga Sanctuary Yoga Teacher Training Program: Tuition $2200.00 paid in full $2400.00 with payment plan Administration/Registration Fee $100.00 Books/Supplies $50.00 Total Program Cost $2350.00 – $2550.00 Additional InformationA deposit of $300.00 ($200.00 to be applied to Tuition and $100.00 for the non-refundable registration fee) must accompany the enrollment agreement to secure a space in the program. Once you have completed this online form, you will need to register for the program in KarmaSoft and pay this deposit; your application is not considered complete until both this contract and the KarmaSoft deposit are completed. Payment of Tuition Yoga Sanctuary of Belleville Yoga Teacher Training does not provide any loans or grants. A tuition payment plan is available on a case-by-case basis. The payment plan must be in writing prior to the start date of program. Cancellation and Refund Policy Rejection: An applicant denied admission is entitled to a refund of all monies paid. Three-Day Cancellation: An applicant who provides written notice of cancellation within three days (excluding Saturdays, Sundays, and federal and state holidays) of signing an enrollment agreement is entitled to a refund of all monies paid. No later than 30 days of receiving the notice of cancellation, the school shall provide the 100% refund. Other Cancellations: An applicant requesting cancellation more than three days after signing an enrollment agreement and making an initial payment, but prior to entering the school, is entitled to a refund of all monies paid minus a registration fee of $100.00. Refund after the commencement of classes 1. Procedure for withdrawal/withdrawal date: A student choosing to withdraw from the school after the commencement of classes is to provide written notice to the Director of the school. The notice is to indicate the expected last date of attendance and be signed and dated by the student. For a student who is on authorized Leave of Absence, the withdraw date is the date the student was scheduled to return from the Leave and failed to do so. A student will be determined to be withdrawn from the institution if the student has not attended any class for 12 consecutive class days. All refunds will be issued within 30 days of the determination of the withdrawal date, following the refund schedule below. 2. Tuition charges/refunds: Before the beginning of classes, the student is entitled to a refund of 100% of the tuition (less the $100.00 registration fee). After the commencement of classes, the tuition refund minus the registration fee of $100.00 shall be determined as follows: % of the Clock Hours Elapsed: Tuition Refund Amount: 10% or less 90% refund More than 10% and less than or equal to 20% 80% refund More than 20% and less than or equal to 30% 70% refund More than 30% and less than or equal to 40% 60% refund More than 40% and less than or equal to 50% 50% refund More than 50% No Refund The percentage of the clock hours attempted is determined by dividing the total number of clock hours elapsed from the student’s start date to the student’s last day of attendance, by the total number of clock hours in the program. 3. Books, supplies and fees: There is no refund for equipment, books and supplies received by the student. 4. Special Cases: In case of prolonged illness or accident, death in the family, or other circumstances that make it impractical for the student to complete the program, the school may make a settlement which is reasonable and fair. Refunds will be issued within 30 days of the date of student notification, or date of school determination (withdrawn due to absences or other criteria as specified in the school agreement), or in the case of a student not returning from an authorized Leave of Absence (LOA), within 30 days of the date the student was scheduled to return from the LOA and did not return. THE STUDENT UNDERSTANDS: 1. The School does not accept credit for previous education, training, work experience (experimental learning) or CLEP. 2. The School does not guarantee job placement to graduates upon program/course completion or upon graduation. 3. The School reserves the right to reschedule the program start date when the number of students scheduled is too small. 4. The School will not be responsible for any statement of policy or procedure that does not appear in the School syllabus. 5. The School reserves the right to discontinue any students’ training for unsatisfactory progress, nonpayment of tuition or failure to abide by School policy. 6. The School does not guarantee the transferability of credits to a college, university or institution. Any decision on the comparability, appropriateness and applicability of credits and whether they should be accepted is the decision of the receiving institution. 7. This document does not constitute a binding agreement until accepted in writing by all parties.> LETTER OF RECOMMENDATION: Please submit at least one letter of recommendation from a person that knows your personal practice background. The registration process will remain pending until receipt of the recommendation. You or the writer of your letter may email your letter of recommendation to firstname.lastname@example.org, or mail it to the studio at 1400 East B Street, Belleville, IL 62220. The letter may also be dropped off in person at the studio. PERSONAL INFORMATION PRIVACY: Yoga Sanctuary of Belleville will never share your personal information, provided in this agreement, with any third party.Student AcknowledgementsAttendance/Performance Acknowledgement*I understand that the School may terminate my enrollment if I fail to comply with attendance, academic and financial requirements or if I disrupt the normal activities of the School while enrolled in the School. I understand that I must maintain Satisfactory Academic Progress as described in the School syllabus and that my financial obligation to the school must be paid in full before a certificate may be awarded. I understand/agree Job Placement Acknowledgement*I also understand that this institution does not guarantee job placement to graduates upon program/course completion or upon graduation. I understand/agree Contract AcceptanceI, the undersigned, have read and understand this agreement and acknowledge receipt of a copy. It is further understood and agreed that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the School Official. I also understand that if I default upon this agreement, I will be responsible for payment of any collection fees or attorney fees incurred by Yoga Sanctuary of Belleville Yoga Teacher Training. Electronic Signature* I understand that checking this box and typing my name in the box below constitutes a legal signature confirming that I have read and understand all aspects of this agreement and do recognize my legal responsibilities in regard to this contract. Electronic Signature (typed name):*NameThis field is for validation purposes and should be left unchanged.