Yoga Teacher Training Application

Etowah Valley Yoga Teacher Training Application

Application Form

Name___________________________________________________________________

Address_________________________________________________________________

City_________________State______________________Zip______________________

Phone cell___________________home__________________Work_________________

E-mail Address______________________________Fax#_________________________

Medical Information

Any ailments or physical limitations?__________________________________________

Back or neck concerns?____________________________________________________

Hip or Knee problems?_____________________________________________________

Surgery within Last year?___________________________________________________

Rx medications?__________________________________________________________

Are you pregnant?_________________________________________________________

Do you currently follow any exercise program?__________________________________

 

Interest and Experience in Yoga

How long have you been practicing yoga?______________________________________

What is your current Yoga experience?________________________________________

________________________________________________________________________

________________________________________________________________________

What styles of yoga have you been taught or trained in?___________________________

________________________________________________________________________

________________________________________________________________________

Do you plan to teach yoga or are you taking this course to improve your personal

practice?________________________________________________________________

________________________________________________________________________

_______________________________________________________________________

Any Additional Comments__________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signature______________________________________Date_______________________

 

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New Students

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