Chakra Workshop Application

Healing through the chakras application

* Indicates required field

Name *

First

Last

Parent/Guardian Name (If 18 or younger) *

First

Last

Email *

Phone Number *

Emergency Contact *

First

Last

Phone Number *

Session Start Date *

Where do you live? *

How did you hear about this training? *

Peaceful World Yoga may use photographs or videos for marketing purposes and future workshops and trianings. Participants will not be named or compensated. May we photograph/video tape you? *

Yes No

Special instructions, questions, concerns or anything else you would like us to know? *

What are your hopes or goals for this training? *

What are your fears? *

Liability Disclaimer & Notices (please read carefully)

I as parent and/or guardian of the minor child identified above/or participant, hereby acknowledge the following notices and grant to Peaceful World Yoga, LLC the following release from liability:

I acknowledge and fully understand that I will be engaging in physical activities that may involve some risk of injury. I acknowledge and have been advised that it is my responsibility to consult with my physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my participation. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained which might incur as a result of participating in this program and discharge and hold harmless Peaceful World Yoga, its owners, staff and instructors from any claim, cause of action or liability for damages arising from any personal injury to myself or other persons or property caused by my participation in the Peaceful World Yoga Healing Through the Chakras Workshop.

I give full permission for any person connected with Peaceful World Yoga and/or the hosting organization to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care and to transport me to a medical facility deemed necessary for my well being.
I clearly understand that all registrations are non-refundable and that if I miss any classes or decide the class is not a good fit, there will be no partial reimbursements or make-up classes.

Electronic Acceptance *

I have read and accept the Liability Waiver

Date *

***** PAYMENT OPTIONS*****

Please send payment to:
Peaceful World Yoga, LLC
10198 Julian Way
Westminster, CO 80031

Peaceful World Yoga now accepts Venmo payments. Please send Venmo payments to @Melissa-Spencer-11
Sign up for a free account at venmo.com/

Additional Information

Please arrive 15 minutes prior to class beginning so we can start promptly at 10:00 am. Classes will end at 12:00 pm unless otherwise decided on by the group as a whole. Particapants have the option to stay and answer questions or sit in meditation until 12:30 pm.

Feeling generous? Add $1, $5, $10, $15 or more to your workshop tution and allow for children who can't afford Yoga and Mindfulness classes to be able to participate in lower-social economic areas, shelters, Safe Houses, and other facilities were our Peaceful World Yoga Tribe teach. A few extra dollars can change the life of a child in so many ways.

Yoga Mats are provided and can also be purchased through Peaceful World Yoga. Prices for mats vary depending on brand.

If you have any questions or concerns, please contact us at peacefulworldyoga@gmail.com

Electronic Acceptance *

I have read and acknowledge the above information

Submit

Purchase a Yoga Mat

(1) Standard size student yoga mat. It is recommended to purchase your child's mat prior to the first class of the session, however, mats can be purchased at any time prior to the final week of the session. Yoga mats purchased through Peaceful World Yoga will be delivered to your child at the first class following purchase (please allow 2-3 days lead time).

Click link below to review mats

https://www.reviews.com/best-yoga-mat/

Healing through the chakras application

Purchase a Yoga Mat

​Click link below to review mats

Click link below to review mats