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Intouch Yoga Teacher Training Registration Form
Flo Fenton
2017-05-30T12:21:52+10:00
INTOUCH YOGA TEACHER TRAINING REGISTRATION FORM
Please note that all information gathered is strictly confidential, and will be shared only with Intouch Yoga teaching staff as needed.
PERSONAL DETAILS
Name
*
First
Last
Email
*
Enter Email
Confirm Email
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Your Gender
*
Male
Female
Which Training Level are you applying for?
*
Level 1 - Part Time
Level 1 - Full Time
Level 2
Please supply details of your current Level 1 Yoga Teaching Training qualifications
*
List any other Yoga Training Qualifications
*
Name of Training
*
Focus of the Training
*
Date Graduated
*
MM slash DD slash YYYY
Date of Birth
Mobile Phone Number
*
Home Phone Number
*
Emergency Contact Phone
*
Emergency Contact Person
*
First
Last
Passport Type
(Foreign Students only)
Passport Number
Do you have a minimum level of Engligh language proficiency, both written & oral?
HEALTH & FITNESS
Do you have any physical health conditions?
Do you have any physical injuries?
Have you ever had any surgery?
Are you taking any medication?
Do you smoke or drink or take other recreational drugs?
NOTE: There is no discrimination implied and these questions are only used in a confidential manner, and to aid your overall health assessment).
What is the level of your physical fitness?
*
Below Average
Average
Above Average
MENTAL & EMOTIONAL HEALTH
Do you suffer from any form of mental illness or emotional instability?
Have you ever received treatment for your mental health?
Have you ever spent time in a meditation retreat or do you have a regular meditation practice?
YOGA EXPERIENCE & PRACTICE
What style of Yoga do you practice?
Do you attend regular classes?
Are you currently teaching?
Do you have a self-practice?
What areas of your Yoga practice do you have difficulty with?
List any Yoga related qualifications you have or any retreats/courses attended with other teachers
THANK YOU FOR COMPLETING THIS QUESTIONNAIRE
The answers to your questions help us to gauge your readiness for this course, and to assist you in your journey. Please note that completion of this questionnaire does not guarantee you a place on the course. You will be notified as to your acceptance. Once you are accepted into the course you will be required to sign a disclaimer form, and pay your non-refundable deposit. On receipt of your deposit your place will be secured.
DECLARATION
*
Yes
I declare I have disclosed on this form all relevant details and by submitting these details to Intouch Yoga I take full responsibility for myself in attending this course.
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