Training & Workshop Registration Form

Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number:*

Area CodePhone Number

Name/Phone Number of Emergency Contact *

Name of the Training/Workshop *

Date of the Training/Workshop *

Date

Registration Fee *

USD

WAIVER OF LIABILITY

It is your responsibility to inform the instructor of your limitations before class begins. I represent and warrant that I am in good physical health and do not suffer from any medical condition which would limit my participation in the classes offered at Your Sunshine. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any of the classes, programs, or workshops. I understand the risks associated with the activities offered by Your Sunshine and I agree to follow all instructions so that I may safely participate in classes, workshops, or other activities. I hereby WAIVE AND RELEASE Your Sunshine, its owners, officers, employees, and instructors from any claim, demand, cause of action of any kind resulting from or related to my participation in the programs. In taking part in the classes, workshops, or other activities at Your Sunshine, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages, known or unknown, which might occur as a result of my participation in the classes, workshops, or other activities. I have read the above release and waiver of liability and fully understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above.

USE OF PHOTOS

Your Sunshine includes photos of Your Sunshine activities on its website, educational materials, publications, & advertisements. In such materials Your Sunshine will not identify any individual student by name unless specifically and separately authorized. By signing this release form you are hereby granting permission to Your Sunshine, its representatives and employees the right to take photographs of classes and authorize Your Sunshine, its assigns and transferees to copyright, use and publish the same in print and/or electronically for any lawful purpose, including such purposes as publicity, illustration, advertising, & web content. If you give permission for Your Sunshine to use photos, please indicate by initialing below.

Signature

By clicking the "Pay Now" button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you about your Membership.

Thank you!

Training/Workshop Registration