YEAS!
Yoga Education for Autism Spectrum

Registration Form
Send Check To PO Box 156481, San Francisco, CA 94115
Check made out to Kahlon Family Services
Or you can pay through via PayPal to: kahlonfamilyservices@gmail.com

Click here to download a PDF registration form.

*Required Fields

*Training Location and Date:
*First Name, Middle Initial, *Last Name:
*Address:
*City, State, Zip:	Outside USA Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Home Phone:
Work Phone:
Mobile Phone:
*Email Address:
Current Profession:
How long have you been practicing yoga?:
Are you a yoga instructor?:	Yes No
If yes, where do you teach yoga and what kind of yoga?:
Do you have any experiernce working with children who have Autism or Special Needs?:	Yes No
If yes, please explain and for how long?:
Have you taken teacher trainings before?:	Yes No
Why do you want to attend KFS training for chidlren who have Autism?:
What do you want to learn with this training?:
How did you hear about KFS training?:
How do you envision yoga for children who have special needs?:
Any questions you want answered at the training when you are working with children who have Autism?:
Anything else?:
Waiver and Release
By submitting this form, I release Kahlon Familly Services, Vanessa Kahlon, and KFS facilitators, employees, assistants, staff and all sponsoring agencies from responsibility for any injuries I may receive as a result of participation in this course. I certify that my level of physical condition as determined by myself or my physician will allow me to safely participate in this program. I realize that completion of this course is in recognition of training rather than a statement of certification in being a fully qualified yoga instructor. I understand that I will receive a certificate of completion for class hours that I participate in this course. Though Kahlon Family Services endeavors to impact the importance of integrity and ethics in children's yoga teachers, I agree that Kahlon Family Serivcs is not responsible for the actions of those who have taken training in this course. I understand that the name Kahlon Family Servics is the property of Vanessa Kahlon, and as such is not appropriate as the title of children's yoga courses or classes that I may offer. It is entirely appropriate for Kahlon Family Serivcs- YEAS to be listed in my course bio or resume as a statement of my training. I have read this release and am legally competent to sign this statement.

Kahlon Family Services  |  Phone: 415-971-8214  |  Email: info@kahlonfamilyservices.com