COPY AND PASTE THIS REGISTRATION FORM INTO AN EMAIL TO: whitecloudnm@aol.com

You will be contacted by phone, and email when this form is received.

Course Registration Form

Name:

Mailing Address:

Phone Number:

Work Phone: Cell Phone:

E-mail Address:

Name of Class:

Date(s) of Class:

Form of Payment:

Credit Card Number:

Expiration Date                                                 3 digit code on back of card

Have You Taken A Class With us Before?

If so, what class?

White Cloud Institute, PO Box 31996 Bellingham, WA 98228

E-mail us at: WhiteCloudNM@aol.com or call 505 670-3538

We can take a credit card for payment over the phone.

In order to guarantee your space in class a $75 non refundable deposit is due when you register. Full tuition is due 2 weeks prior to class. No tuition refunds will be made within a week of class or once a class begins.

White Cloud Institute

Student Consent Form

In agreeing to register for classes with White Cloud Institute, you are verifying that you have not been sick in the past 2 weeks, or to the best of your knowledge, been in contact with anyone who is sick.

If you have any of the following symptoms please stay home to rest.

• Cough

• Fever

• Shortness of breath, difficulty breathing

• Muscle aches

• Sore throat

• A general feeling of being unwell or confused

Loss of taste or smell

Skin Rash

•Cancellation Policy

If you need to reschedule or cancel because you are not feeling well, I understand and request for you to please contact me as soon as possible.  

Acknowledgement and Release

I hereby acknowledge that I have read the foregoing White Cloud Institute Student class Consent Form. I release Caryn Diel from any and all claims of malpractice, non-disclosure, or lack of informed consent. I freely assume any and all risks, whether presently contemplated or hereinafter discovered.

Signed___________________________________________Date_________