Boise, ID Spring 2020 Level One Application
Level One Kundalini Yoga Teacher Training
Boise, ID Spring 2020
Email address *
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Email *
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Address *
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Phone # *
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Birthdate *
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Are you currently taking Kundalini Yoga Classes?If Yes, How Long? *
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Who is your Instructor? *
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Do you have a regular yoga/meditation practice?If yes, please give details. *
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Do you practice or teach any other form of Yoga? If yes, what form, Training or other details *
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Are you taking this course for certification to teach Kundalini Yoga? *
What recent spiritual events have you attended or books, ecourse, lectures have you studied or participated in during the last 12 months? *
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Please write your intention or goal for taking this course. *
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HEALTH QUESTIONNAIRE:
If you answer yes to any of the following questions, please describe fully (use a separate page if necessary.) In addition to this form you may be asked to provide a letter from your healthcare provider.
Are you currently under medical treatment for any physical or psychological condition? If yes describe: *
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In the past have you been under medical treatment for any physical or psychological condition?If yes give the date and describe: *
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Were you ever hospitalized for a physical or psychiatric condition?If yes, give dates and describe: *
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Do you have any chronic physical limitations or disabilities? If yes, describe: *
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Are you currently pregnant or trying to get pregnant? *
Do you have a communicable disease? *
Are you in recovery from a drug/alcohol addiction? *
If you answered yes to the previous Question, please state how many years have you been in recovery?
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Describe your weekly alcohol/recreational drug consumption: *
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Do you Smoke? *
If you smoke do you intend to quite before the start of this training?
Are you taking any medications at this time? *
What types of exercise or physical activities do you participate in regularly and how often? *
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Do you have any medical condition which might prevent you from participating in the full Teacher Training Program? If so, explain: *
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Full Disclosure and Acceptance of Terms
Siri Neel Kaur Khalsa and KRI must be able to rely on the accuracy and completeness of information provided by the applicant. Information provided is treated as confidential and disclosed only to those with a legitimate need to know in delivering the training. Therefore, all registrants are required to answer all questions fully and in truth. By signing below, I affirm that the information provided in the Yogic and Health Questionnaires is to the best of my knowledge, true and complete. I understand that providing inaccurate, incomplete or misleading information will be grounds for rejection of my application, during the Program being requested to leave the program before completion (without refund) or after certification grounds for revocation of my certification. If I must leave the program because of a health consideration or family challenge continuing in another session is at the discretion of Siri Neel Kaur Khalsa. I agree to discuss any health restrictions, questions or concerns with Siri Neel Kaur prior to the Course. I understand that no refunds are given after the start of the course.
Do you accept the terms as stated above? *
If you accept the terms and would like to submit your application please print your name and date below. *
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A copy of your responses will be emailed to the address you provided.
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