Class Registration Form

Class Registration Form
Full Name: *

First Name Last Name
E-mail: *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
What is your profession? *
Are you NCBTMB Certified? *

Yes No
Have you studied CST before? *

Yes No
How would you like your name and titles to appear on your certificate of completion? *
When and with whom have you studied CST?
Have you studied other kinds of bodywork? *

Yes No
Which kinds of bodywork have you studied?
Do you attend births? *

Yes No
What is your role at births?
Why do you want to study with Carol Gray? *
Select and Pay For Classes. *

CST for Infants October 23-27, 2017 $ 1,300.00

Subtle Hands-On Skills November 8-10, 2017 $ 650.00

CST for Pregnancy Birth & Postpartum November 13-17, 2017 $ 1,300.00

Subtle Hands-On Skills March 7-9, 2018 $ 650.00

CST for Infants March 12-16, 2018 $ 1,300.00

CST for Infants Advanced Clinical Skills April 4-6, 2018 $ 750.00

MamaSpace Yoga Prescriptions April 25-28, 2018 $ 900.00

Subtle Hands-On Skills May 9-11, 2018 $ 650.00

CST for Pregnancy Birth & Postpartum May 14-18, 2018 $ 1,300.00

Subtle Hands-On Skills July 11-13, 2018 $ 650.00

CST for Infants July 16-20, 2018 $ 1,300.00

Supporting Emotional Release August 6-10, 2018 $ 1,400.00

Subtle Hands-On Skills August 15-17, 2018 $ 650.00

CST - The Basics August 22-24, 2018 $ 750.00

CST - Beyond the Basics August 27-29, 2018 $ 750.00

CST for Pregnancy Birth & Postpartum - Advanced Clinical Skills September 10-12, 2018 $ 750.00

Subtle Hands-On Skills October 17-19, 2018 $ 650.00

CST for Infants October 22-26, 2018 $ 1,300.00

Subtle Hands-On Skills November 7-9, 2018 $ 650.00

CST for Pregnancy Birth & Postpartum November 12-16, 2018 $ 1,300.00

Total: $ 0.00
CANCELLATION AND REFUND POLICY: Tuition is fully refundable up to 30 days prior to the start of a class or may be applied to another class at any time. There are no refunds given for cancellations made less than 30 days prior to the start of a class. *

I have read and I agree to the terms of the cancellation and refund policy.
TERMS AND CONDITIONS: In consideration for being permitted to study Craniosacral Therapy or yoga with Carol Gray LLC (CG), use CG's facilities and equipment, participate in any of CG's classes and programs or avail myself of CG's services, I agree to abide by all rules and regulations established by CG and I hereby release CG, its officers, employees, instructors, trainers, agents or representatives (the "Releasees") from all liability to the undersigned, my personal representatives, assigns, heirs and next of kin for any and all present and future claims for any loss, damage, theft of personal property, personal injury, bodily injury or death, whether caused by the negligence of the Releasees or otherwise, arising as a result of my use of CG's facilities or equipment, participation in any of CG's classes or programs or receipt of any CG services, including personal training services (collectively, "CG activities"). I further waive and covenant not to sue Releasees for any such claims. I understand and acknowledge the nature and extent of my CG activities, are voluntarily. I further agree to indemnify and hold harmless the Releasees from any loss, liability, damage or cost, including attorneys' fees, that may incur due to my use of CG facilities or equipment, or participation in any of CG's classes or programs, or receipt of any CG services, whether caused by the negligence of the Releasees or otherwise. I further agree that this Release, Waiver and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Oregon and that if any portion hereof is held invalid, the remainder of the Agreement will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in Multnomah County, Oregon. I affirm that I am of legal age and am freely signing this Agreement. I have read this Agreement and fully understand that I am giving up legal rights and remedies that I might have now or in the future. *

I have read and I agree to the Terms and Conditions.
Comments or Special Instructions:
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