200hr Gentle Yoga Teacher Training Application
Email address *
Date *
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Name *
Address *
Email *
Phone Number *
Please tell us your reasons for taking this training? *
Which session are you applying for?
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How did you hear about this training? *
Required
Your Yoga History
How long have you been practicing? *
What tradition(s) or style(s) do you practice? *
How often do you practice? *
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 *
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DD
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YYYY
Please briefly describe your current overall health. *
Describe any history (include dates) of back/spine/neck problems and indicate whether they are still problematic. Please be specific. *
Describe any history (include dates) of join problems (knee/hip/shoulder/etc), including joint repair/replacement surgeries. Please be specific. *
Blood Pressure *
When was your blood pressure last checked? *
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DD
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YYYY
Have you ever taken blood pressure medication? *
If yes, how recently? *
Have you ever experienced any of the following? *
Required
Describe any history (even if you are at risk) of cardiovascular problems. *
Do you have any other limitations, dietary restrictions, or health concerns? If so, please explain. *
If you have any learning disabilities or other special physical or psychological circumstances, please explain so we can better serve you during this program.
Women: Are you pregnant?
Clear selection
If yes, what is your due date?
Emergency Contact
Name *
Relationship *
Phone number *
Email *
I hereby certify that the above information is correct to the best of my knowledge. *
A copy of your responses will be emailed to the address you provided.
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