First/ Last Name *

Email *

Phone Number *

Address

Date of Birth *

Emergency Contact Name & Phone.

Skype Username

Facebook Profile

What style(s) of Yoga do you practice regularly?

Are you a yoga teacher?

If you're an active yoga teacher, what classes do you teach and what kind of community do you serve?

How long is your daily practice (in hours)?

If you meditate, how long have you been meditating, and how often do you meditate?

Approximately what year did you start to practice and/or teach Yoga?

Please provide the names of your principal teachers or schools.

Do you suffer from any medical condition? Are you taking any medications?

If you are under medical treatment or supervision, please tell us about it as thoroughly as you can.

Do you have any personal trauma history? If so, please provide details, as well as the healing work that you've done in recovery from your personal trauma.

If you are currently receiving psychotherapy, psychiatric treatment, and/or counselling, please tell us about the history and processes you are using currently.

If you are using any prescription medication, please indicate type, dosage, and frequency of intake.

Are you currently experiencing any injuries?

Is this your first time to Nepal?

How did you hear about this Yoga Teacher Training?

What is your main interest in taking a trauma informed training - personal trauma healing?

Dietary restrictions *

I have read and understood our Yoga Teacher Training terms and conditions, and will be fully responsible for you are responsible for your own health and wellbeing during the retreat. Atira Tan & Gemini Adams will not be held liable for any injuries or other medical or mental health problems that may occur, are sustained or aggravated during or after your time on this training. *