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Personal Information

First Name

Last Name

Street Address

City

State

Zip

Phone

Email


Let Us Know About Your Physical Health

Date of Birth

Sex
MaleFemale

Current Occupation

Emergency Contact

Phone

Relationship

Give us an assessment of your current physical health
ChallengedFairGoodExcellent

Are you currently, or during the last 2 years been, under the care of a physician/other health care professional?
YesNo

If yes, for what reason?

Please list the health care professional's name, specialty, and address:

Name

Specialty

Address

Do you have epilepsy?
YesNo

Do you have diabetes?
YesNo

Please list any medications you are currently taking or have taken in the last year that were prescribed by a health care professional

Are you currently, or during the last two years, have you been under the care or supervision of a mental health professional (psychiatrist, therapist, etc.)?
YesNo

If yes, for what condition?

Please list the mental health professional's name, specialty, and address:

Name

Specialty

Address

Please list any medications you are currently taking that were prescribed by a mental health professional

Have you been hospitalized in the last year?
YesNo

If yes, for what condition?

Do you have any special dietary requirements?
YesNo

If yes, please list

Do you have any challenges participating in any physical activities?
YesNo

If yes, please list

Do you smoke?
YesNo

Do you drink alcohol?
YesNo

If yes, how much and how often?

Do you use drugs?
YesNo

If yes, how much and how often?


Additional Information

Please describe your yoga background

What yoga style do you practice?

Why do you practice yoga? And how long have you been practicing?

How often do you practice?

Please list your most-influential teachers and styles. How often and for how long have you studied with them?

Why do you want to become a yoga teacher? If you have chosen this training simply for personal growth and have no intention to teach, what do you hope to gain?

What schooling or training have you had that would provide a useful background or would be an asset to you in your teacher training? (massage, medical/anatomical studies, teaching in other disciplines, university degress, etc.)

If you teach now, tell us about your teaching history

Do you have any pre-existing injuries that may affect your ability to participate in this course?

What are your top two intentions for personal growth?

In addition to your application please submit a digital photo to Julie and Heather at hotyogachicks@gmail.com


Payment Requirements

Upon submitting your application, you will be redirected to a page where you can make a deposit payment of $500. The remainder of payment must be received prior to the start of training. All monies are non-refundable and non-transferable. Payment can be made online via PayPal/credit card or by check.