Yujom® Individual System Joining Form

Individual System & Contribution Selection

Select the first-year participation option. The selected contribution will be confirmed before payment processing.

DreamSleep® + Trio Activities - With Group Counsellor Support

With Assessment: First-year contribution ₹2,51,000
Without Assessment: First-year contribution ₹51,000

Annual renewal shown in the current contribution schedule: ₹51,000. Renewal is not being collected through this joining form.

Select Your First-Year Participation Option(Required)

With Assessment - ₹2,51,000

Without Assessment - ₹51,000

Choose one option. Assessment is included only in the ₹2,51,000 option.

Who Is Being Registered?(Required)

Myself

My Child / Dependent

Another Family Member

Participant Age Group(Required)

Under 18 years

18 years or older

Participant Details

Enter the details of the person who will participate in the Individual System.

Participant Full Name(Required)

Date of Birth(Required)

ID Proof - Copy of Aadhaar Card(Required)

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Upload JPG, JPEG, PNG or PDF; maximum 5 MB.

Gender

Participant Email Address(Required)

Enter Email Confirm Email

Participant Mobile / WhatsApp Number(Required)

School / College / Occupation(Required)

Enter the present class/course and institution, or occupation.

Preferred Communication Language(Required)

For example: Gujarati, Hindi or English.

Postal Address(Required)

City(Required)

State(Required)

Postal / PIN Code(Required)

Country(Required)

Accessibility or Participation Support Needed

Optional. Mention only information relevant to participating in online sessions and activities.

Parent / Guardian Details

Required when the participant is under 18 years of age.

Parent / Guardian Full Name(Required)

Relationship to Participant(Required)

Parent / Guardian Mobile / WhatsApp Number(Required)

Parent / Guardian Email Address(Required)

Enter Email Confirm Email

Parent / Guardian Consent(Required)

I am the parent/legal guardian of the minor participant, and I consent to their participation and to communication with me regarding the program.

Partner / Member Reference

These details help apply any stated participant concession and correctly track the introducing partner or member.

Partner / Coupon Code

Enter the code supplied by the introducing Yujom® Partner, if applicable.

Contribution Payment Status

Referring Member Name / Member ID

Optional. Complete this when an existing member referred the participant.

Payment Date

Amount Paid

Enter the amount in Indian rupees.

Transaction / UTR Reference Number

Payment Proof

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Upload JPG, JPEG, PNG or PDF; maximum 5 MB.

Review & Declaration

Please confirm every applicable statement before submitting the joining form.

First-year contribution: ₹2,51,000 with assessment, or ₹51,000 without assessment. Final acceptance and payment verification are subject to the official Yujom® process.

Contribution Confirmation(Required)

I have reviewed the selected first-year contribution amount and understand that the assessment is included only in the ₹2,51,000 option.

Program Nature(Required)

I understand that the Individual System is a wellness, learning and developmental participation system and is not a substitute for medical diagnosis or treatment.

Accuracy of Information(Required)

I confirm that the information provided in this form is accurate and complete to the best of my knowledge.

Communication & Participation Consent(Required)

I consent to being contacted about registration, payment verification, scheduling, participation guidance and related official communication.

Privacy Consent(Required)

I consent to Yujom® collecting and using the submitted information for registration, verification, participation administration and related communication.

Typed Full Name / Electronic Signature(Required)

For a minor participant, the parent or legal guardian must type their full name.

Declaration Date(Required)

Name

This field is for validation purposes and should be left unchanged.