Yoga Teacher Training Registration Form

Please fill out the form below to inquire or begin registration.

General Information

First Name: *

Last Name: *

Gender:

Address 1:

Address 2:

Province / State:

City:

Country:

Home Phone:

Work Phone - Ext:

Mobile Phone:

Email:

Date of Birth:

(YYYY/MM/DD)

Education / Yoga Experience

High School Graduate:

Post Secondary Education:

Occupation:

Do you teach yoga now?:

If yes, please describe in detail what/where you teach:

If no, please explain why you want to teach yoga:

Please describe your background with yoga:

Have you studied any other Eastern systems of the body?:

(eg. Tai Chi, bodywork, Karate, acupuncture)

Have you studied any Western based system of the body?:

(eg. dance, Pilates, Feldenkrais)

Have you ever been injured as a result of your yoga practice? If yes, please describe in detail:

Are you using any prescribed medication?:

If yes, please name medication, reason, and give brief medical history:

Other

What are your interests and hobbies (besides yoga)?:

Which training are you applying for:

How did you hear about our program?:

Discuss the reasons you choose to take this yoga training:

(ie: goals, enhance personal yoga practice, personal development skill)

Please add anything else you want us to know about yourself or your involvement with yoga: