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MR
MRS
MS
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AFGHANISTAN
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Home Phone Number *
Cell Phone Number *
Occupation/Vocation *
Training Location(s) you are interested in *
How long have you been practicing Yoga? Please describe your background in yoga studies (teacher's names, Yoga styles, etc.) *
Have you been taking regular classes for at least 6 months? *
Do you have a daily Yoga practice? Please describe your practice. When did you start and how long do you practice each day? *
Do you have a background teaching Yoga and/or other teaching experience? *
Are you currently teaching Yoga? If so, number of classes per week? What traditions, styles and for how long? *
What does Yoga mean to you, and how has it affected your life? *
Why do you want to take this training? What are your expectations of it and how will you utilize your Certification? *
Are you certified in other areas? *
In your opinion what does a Yoga teacher provide for his/her students? What would you like to be able to provide to your students as a Yoga teacher? *
How did you hear about yogaspirit® Studios training program? *
Internet Search
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yogaspirit® Studios: Health Information Form and Waiver
Are you currently under medical treatment or supervision for:
Chronic Physical Limitations/Physical challenges (e.g. vision, hearing, movement, high blood pressure, asthma, etc.) Please describe the nature and extent of limitation(s) if any:
Serious illness or surgery within the last five years (e.g. heart, cancer, diabetes, etc.) Condition and date(s): *
Any other surgery/procedures:
Prescription medications:
Drug or alcohol addictions:
Are you currently pregnant? *
Yes
No
If yes, number of months at start of program?
Have you ever been hospitalized for anxiety/panic attack, emotional/mental condition?
Emergency Contact Information: Please provide us with an Emergency Contact person
Name *
Telephone *
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Physician Name *
Physician Telephone *
DECLARATION OF DISCLOSURE AND ACCEPTANCE OF TERMS:
I hereby declare the above information is true to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for revocation of Certification. I have enrolled in a Teacher Training Program of physical activity including, but not limited to various yoga and meditation exercises offered by yogaspirit® Studios. I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in this exercise program. I release yogaspirit® from any liability now, or in the future, including but no limited to: heart attacks, muscle strains, pulls, tears and broken bones, shin splints, heat prostration, knee, lower back or foot injuries and any other illness, soreness or injury, however caused, occurring during or after my participation in this program.
I understand that I am entitled to no refunds, credits or adjustments resulting from my failure to complete the certification requirements or to uphold any of these conditions.
I accept the above terms and conditions *
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