Intouch Yoga Teacher Training Registration Form

PERSONAL DETAILS

Name*

First Last

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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*

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.

JOIN ME UP FOR YOUR NEWSLETTER