Name
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First Name
Last Name
Email
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Date of Birth
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
I am a:
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Recovery Specialist
Not a Recovery Specialist
Thanks to a specialized grant, we are offering scholarships to 10 peer recovery specialists; are you applying for a scholarship based upon this criteria
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YES
NO
How did you hear about this training?
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What styles of yoga / meditation have you been practicing and for how long?
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Please describe your current practice including any challenges and inspirations.
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If you are a peer recovery specialist, please tell us where and for how long:
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Have you practiced with Shara Plynton before?
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How would you like to use this training after completion?
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In terms you are comfortable to share, how would you describe your overall physical and mental health? Please include any information about any injuries or trauma to the extent you feel comfortable.
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Please describe your educational background.
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Is there anything you would like to add?
PROGRAM POLICIES: I understand that my physical, mental and emotional well-being is my own responsibility and that this program and those teaching it are not responsible for any injuries sustained during this program. I assume all responsibility for any risks involved in completing this program, and I have filled out a new student registration form by creating an online account with Shri before I began the training. After creating my online account, I understand that my online payment for tuition will be made in full before training through our online scheduling system link sent to me after acceptance into this program, if I am not coming as a free participant. I understand this is not a therapeutic program and will consult my doctor/therapist to make sure it is safe for me to participate in a program like this one that can require self-reflection and may challenge me physically, emotionally and / or spiritually. I understand that this training will follow all laws (state and federal) and CDC guidelines regarding COVID-19. If at any point Shara determines I am unfit for this program, I understand that I will be asked to leave the program with no refund. I understand that no refunds are available after 8/20/23; and before then refunds are only available for 50% of the full contribution to value the organization's holding of space and time. I understand that participation in this training does not guarantee employment at Shri. I also understand that it is my responsibility to attend all scheduled sessions and Shara is not responsible for making up any “lost” training time in which I do not / cannot attend. I understand that a "certification of completion" is not guaranteed and is dependent upon completion of all requirements to the satisfaction of Shara Plynton, director of this training. For any further questions specific about the training components or curriculum, I will contact Shara directly at: sharaplynton@gmail.com.
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If you are satisfied with your answers above, please click "submit," and we will confirm your submission with an email receipt and follow with a private link to complete your tuition online through a secure payment portal. By clicking "submit," you acknowledge that doing so has the same legal effect as your original signature.
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