200hr Hatha Yoga Teacher Training Application
Date
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Name
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Address
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Email
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Phone Number
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Please tell us your reasons for taking this training?
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Which session are you applying for?
How did you hear about this training?
Required
Your Yoga History
How long have you been practicing?
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What tradition(s) or style(s) do you practice?
Your answer
How often do you practice?
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Medical Questionnaire
All responses are strictly confidential. We use this information only to better assist you during the program, not to screen participants, unless participation would be medically inadvisable.
Date of birth
MM
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DD
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YYYY
Please briefly describe your current overall health.
Your answer
Describe any history (include dates) of back/spine/neck problems and indicate whether they are still problematic. Please be specific.
Your answer
Describe any history (include dates) of join problems (knee/hip/shoulder/etc), including joint repair/replacement surgeries. Please be specific.
Your answer
Blood Pressure
When was your blood pressure last checked?
MM
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Have you ever taken blood pressure medication?
If yes, how recently?
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Have you ever experienced any of the following?
Required
Describe any history (even if you are at risk) of cardiovascular problems.
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Do you have any other limitations, dietary restrictions, or health concerns? If so, please explain.
Your answer
If you have any learning disabilities or other special physical or psychological circumstances, please explain so we can better serve you during this program.
Your answer
Women: Are you pregnant?
If yes, what is your due date?
Your answer
Emergency Contact
Name
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Relationship
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Phone number
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Email
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I hereby certify that the above information is correct to the best of my knowledge.
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