Shakti Kriya Eligibility Form
In order to determine your eligibility for Shakti Kriya​, we request you to please complete this form.

Please enter all the information completely and accurately. Once we receive the information we will get back to you within a week regarding your registration to attend Shakti Kriya.

Please Note: This is a pre-screening form only. Filling out this form does not translate into automatic Shakti Kriya attendance. Your registration for Shakti Kriya will be determined based on the information you will be providing us now. If any of the information changes between now and the course date, then you may have to be re-evaluated and your eligibility status might change.

Please do note : All information will remain confidential and will only be shared with the course coordinators.

Jai Guru Dev!

1. Full Name *
(First, Last)
Your answer
2. Email Address *
Your answer
3. Phone Number *
Your answer
4. Age (in years) *
Your answer
5. Please specify your gender *
6. When is the Shakti Kriya you plan to attend in Boone *
MM
/
DD
/
YYYY
7. When was your first Happiness Program/YesPlus course? *
Your answer
8. Have you taken Art of Silence course? *
9. Please share the dates and location of the last Silence course you attended
Your answer
10. Have you participated in Shakti Kriya before? *
11. Please list the date and location when you participated in Shakti Kriya.
Your answer
12. Are you on any medications including vitamins? Please list. *
Your answer
13. Are you under the care of a physician including Psychiatrist, Psychologist or Therapist? *
Your answer
14. List any surgeries you have had in the past 6 months. *
Your answer
15. Do you have any difficulties with your ankles, knee or spine, including surgery? *
Your answer
16. Do you have High Blood Pressure? *
17. If Yes to (16), are you on medications for Blood Pressure? Please list.
Your answer
18. What is your regular Blood Pressure on medication? *
Your answer
19. Are you pregnant (only for women)? *
20. Will you be menstruating/in cycle during the course dates (only for women)? *
21. What else would you like to tell us that its important for us to know as you learn a new practice?
Your answer
Agreement

I have answered the above questions honestly and completely. I have been fully advised and I knowingly take full responsibility for my experience and outcome. I do not hold AOLF, VVM, IAHV (or any associated personnel of these organizations) responsible for my results.

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