Today's Date *

MM

DD

YYYY

First & Last Name *

(as you'd like it to appear on your certificate)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Emergency Contact Number *

Please provide a phone number for your designated Emergency Contact (above)

(###)

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Would you like to opt-in for emailed information of future events? *

Select "Yes" to opt-in to receive emails for future events from us!

Yes!

No thanks

Contractual Agreement *

This agreement is a legally binding instrument when signed by the student and accepted by Integrated Movement and Wellness. Your signature on this agreement acknowledges that you have been given a reasonable amount of time to pay for the teacher training and understand its requirements (dates, times, breaks, schedule, course outline, tools needed). Tuition must be paid in full, all course work requirements successfully completed, and 100% attendance is required in order to receive your certificate. Upon submitting this agreement and payment received to Integrated Movement and Wellness, you will be considered registered for this teacher training. This agreement is for the Advanced Movement Therapy Pilates Teacher Training. Total course hours: 200 hours. Note: You must agree to complete registration.

I agree

Photo Release *

I (insert name below), agree to grant Integrated Movement and Wellness and its staff, any and all rights to photograph me and use my name, picture, silhouette and other physical reproductions of my physical likeness, and to make sound recordings and reproductions of my voice. I hereby irrevocably authorize Integrated Movement and Wellness and its staff to reproduce, copy, exhibit, advertise, publish or distribute any photographs, testimonials, and any reproductions of me, my name, and any part of my physical likeness in any format, now known or hereafter discovered or invented, including, but not limited to, educational motion pictures, film strips, television, websites, magazines, slides and theatrical motion pictures, worldwide. My signature hereto shall constitute a complete release and discharge of any future claim of any kind against Integrated Movement and Wellness, its staff, agents, directors, officers, and assigns. I hereby certify and represent that I have read the foregoing and fully understand the meaning and effect this authorization and release.

I give my consent

I do not give my consent

Release of Liability *

I, the undersigned, am employing Integrated Movement and Wellness for the purpose of instruction. In consideration for this instruction, I hereby release Integrated Movement and Wellness and its agents, employees, and contracted instructors, and agree to hold them harmless from any and all liability, claims, damages, actions, and cause of action whatsoever, for loss, damages, or injury to person or property, irrespective of how arising and however caused, including, but not limited to, all kinds and degrees or extent of negligence with which Integrated Movement and Wellness, its agents, employees, or contracted instructors may be charged in connection, directly or indirectly, with those volunteering to be a demonstration patient. I further agree to disclose in writing below, all of my physical and medical conditions, limitations and sensitivities, and agree to release and hold Integrated Movement and Wellness, its agents, employees, and contracted instructors harmless from any liability, claims, damages, actions and causes of action in any way relating to or arising from said conditions, limitations, or sensitivities. I further agree that Integrated Movement and Wellness, its agents, employees and contracted instructors shall not be liable for any claims, demands, injuries, damages, actions or causes of action whatsoever, arising out of, or connected with, the use of any of its services, facilities or equipment. I hereby expressly forever release and discharge Integrated Movement and Wellness, its agents, employees, and contracted instructors from all such claims, demands, injuries, damages, actions or causes of action, and from all acts of inactive or passive negligence on the part of Integrated Movement and Wellness, its agents, employees, or contracted instructors. Note: You must agree to complete registration.

I agree

Refund & Cancellation Policy *

In the event of a group training, Integrated Movement and Wellness reserves the right to cancel this class due to an insufficient number of registrants. Under these circumstances, a full refund will be issued back to the registered participant. Cancellations by registered participants must be dated and submitted in writing. Cancellations received 60 days or more before the first course date, a full refund will be issued. Cancellations received 30 days or more before the first course date, a registration fee of $250 will be held for administrative fees. Cancellations received less than 30 days of the first course date will receive no refund. If the class is either interrupted or canceled by an act of nature, war, or any issue beyond the control of Integrated Movement and Wellness, the course will be rescheduled. Integrated Movement and Wellness reserves the right to change a course date, location, or instructor. My signature below certifies that I have read, understood, and agreed to my rights and responsibilities, and that the institution’s cancellation and refund policies have been clearly defined and explained to me. Note: You must agree to complete registration.

I agree

Digital Signature Date *

Your digital signature and date are required to complete registration.

MM

DD

YYYY

Payment Instructions *

To complete your registration, course fees of $6,500 must be sent via Paypal (kendelocall@gmail.com) or Zelle (kendelocall@gmail.com) after submitting this Registration Form. Your spot will not be held if payment is not yet received. You will receive an email confirming your full registration once payment is received.

I understand and agree to pay the Course Fee of $6,500