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Kundalini Yoga Teacher Training Program ~ August 2015-July 2016
Level 1
Name:___________________________________________________________________________________________________
Address:_________________________________________________________________________________________________
City:__________________________________________________State:__________Zip:________________________________
Phone:_______________________________________________ Email:_____________________________________________
Emergency Contact:______________________________________Phone:________________________________________
How did you hear about us?______________________________________________________________________________
Class Schedule
All classes are held at Radiance Yoga studio on Saturdays from 9:00am-7:00pm and on Sundays 9:00am-6:00pm
unless otherwise noted. In the event of a scheduling conflict or missed class, students may be permitted to do a
limited amount of make-up work.
August
September
October
October
November
December
January
February
March
April
May
July
29th -30th
19th-20th
17th-18th
24th
21st-22nd
5th-6th
9th-10th
20th-21st
19th-20th
9th-10th
21st-22nd
9th-10th
2015
2015
2015
2015
2015
2015
2016
2016
2016
2016
2016
2016
*White Tantric Yoga at Raj Yoga Center in Sterling, VA.
Pre-registration $145 / $170 after
Tuition
Option 1: $3000 if paid in full by August 1st, 2015
Option 2: $3200 if paid in 4 installments.
Option 3: $3400 if paid in 8 installments.
The following information is needed to proceed with this option.
Name on Card:__________________________________________
Card Number:___________________________________________
Expiration Date:__________________________________________
Authorization for Automatic Bill Payment
Option 2 ____I authorize Radiance Yoga to Charge $800/month on the first day of every month starting August
1st 2015 and ending on November 1st 2015.
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Option 3 ____I authorize Radiance Yoga to Charge $425/month on the first day of every month starting August 1st
2015 and ending on March 1st 2016.
Signature:___________________________________________ Date:____________________________________
Tuition includes:
-200 hours of classroom instruction
-Membership in the International Kundalini Yoga Teacher's Association (IKYTA)
-The Aquarian Teacher Textbook and Kundalini Yoga Manual
Additional Costs
-Day of White Tantric Meditation
-Yoga classes and workshops
-Additional yoga manuals
Refund Policy
There are no refunds or 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 Radiance Yoga and its principals and employees.
I also acknowledge that I understand the refund policy for the Radiance Yoga Teacher Training Program and
agree with the terms. Radiance Yoga 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:
Radiance Yoga
701 Prince Street 2nd Floor
Alexandria, VA 22314
703-535-8282
[email protected]
www.radiance-yoga.net
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Application Questionnaire
1. Can you tell us about your background and experience with Kundalini yoga and other yoga practices?
2. What do 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 has motivated you to join the Kundalini Teacher Training program?
6. Please tell us about any previous teaching experiences.
7. Do you anticipate any times that you will not be able to participate in the scheduled training dates?
8. Do you have any injuries or health conditions that we should know about?
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