Class Application
Fill out this form and either submit it on-line or print and mail it with your payment. You can also bring it with your payment to the first class. If you select PayPal Online Payment, you will be presented with a Pay Now button after submitting the form. We do not give out any information to other parties.
Contact Information
First Name *
Last Name *
Address
City, State, Zip
Email Address *
Work Phone
Home Phone
Cell Phone
Payment Information
If paying by check, please print registration form and mail to address shown below. If paying by cash, please print this form and bring to first session. Please don't submit cash or check registrations online.
Payment Method *
Payment Amount *
Please provide your credit card details below.
Card Type *
Card Number *
Expiration Month *
Expiration Year *
By providing my Credit Card information and submitting this form, I authorize Triad Yoga Institute or their authorized agents and suppliers to charge my credit card in the amount shown above.
I Accept * YesNo

I am physically sound to proceed with instruction in Yoga.
I Agree * YesNo
I declare myself to be responsible for my own health and safety while participating in class. I understand the importance of keeping my teachers informed of any health concerns.
I Agree * YesNo
I declare that I have read and agree with the Triad Yoga Institute's registration information and policies regarding make-up classes and refunds. This information can be found on the registration information page.
I Agree * YesNo
Having read the registration information and policies, I understand that my tuition is non-transferrable and that my class package expires 90 days from the first class used. Classes that are not used before the expiration date are forfeited.
I Agree * YesNo
Comments or Special Requests
Comments
Signature:
Please do not submit this form more than once. You will see a confirmation message here and receive an email to indicate the form was received.