200 Hour Yoga Teacher Training Application
Prior to filling out this form you must read the Criteria for Certification located on
www.yogalotuspond.com/policies-and-course-criteria
Email *
First Name *
Last Name *
Address *
Phone *
Email *
Date of Birth *
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Occupation *
Emergency Contact Name and Phone Number *
Which program are you applying for? *
Required
How did you hear about our program? *
How long have you been practicing yoga? *
What does yoga mean to you? How has your involvement in yoga changed and developed over time? *
Health Information please check yes to all applicable items.
Are you under medical treatment for any physical or psychological condition? *
Required
Are you currently pregnant or trying to get pregnant? *
Required
Have you ever been hospitalized for a psychiatric condition? *
Required
Do you have any chronic physical limitations or disabilities? *
Required
Have you had a serious illness or major surgery within the last 5 years? *
Required
Do you have a communicable disease? *
Required
If you selected yes to any of the above please describe fully below.
Full disclosure and acceptance of terms In order to make informed decisions, The Lotus Pond Center for Yoga and Health must be able to rely on the accuracy and completeness of information provided by applicants. Information provided is treated as confidential and disclosed only to those with a legitimate need to know in administering or delivering the training. Therefore, all applicants are required to answer all questions fully and honestly. By signing below, I affirm that the information provided in this application is to the best of my knowledge true and complete. I understand that providing inaccurate, incomplete, or misleading information is grounds for rejecting this application or for being required to leave the program after I have commenced participation.If I am forced to leave a program because of a health consideration and/or behavioral issues, further participation is at the discretion of the Program Director. I have carefully read the Criteria for Certification and accept the requirements and conditions of this teacher training program. I understand that my failure to meet the criteria will result in my not being certified. I understand that there are always physical risks when participating in a physically active program and that it is solely my responsibility to participate in a manner that is safe for my body
I agree *
Required
Date Completed *
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