Yoga Teacher Training Application

Name*

First Last

Pronouns*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Date of birth*

Emergency contact:

Emergency contact name*

First Last

Emergency contact phone*

Relationship to contact*

Yoga Experience

Please describe your first or favorite experience with yoga.*

Please list the styles of yoga you have experience practicing.*

Please describe your current yoga practice.*

If applicable, please share any influential yoga teachers you have studied with directly.

Getting to Know You

What appeals to you about completing a yoga teacher training?*

Why do you want to participate in Glowing Body Yoga Teacher Training?*

If applicable, what are your specific interest areas related to yoga?

Please tell us about yourself. (Family, work, pets, education, hobbies, etc.)*

What questions do you have for the program director at this time?

The following will be used by our training staff to better assist you during training. Your information will be kept strictly confidential. Please tick the appropriate box and explain any affirmative answers.

Are you taking any prescription medication?

Yes
No

If "yes" please list/describe medications.

Physical limitations or disabilities?

Yes
No

If "yes" please list/describe limitations or disabilities.

Serious illness?

Yes
No

If "yes" please list/describe illnesses.

Surgeries?

Yes
No

If "yes" please list/describe sugeries

Have you or do you use or consume:

Tobacco

Yes
No

Alcohol

Yes
No

Recreational drugs

Yes
No

Illicit substances

Yes
No

If you answered yes to any of the above, please describe your usage.

Please confirm that you understand it is your responsibility to disclose any health information which may be relevent to your training experience.*

I understand it is my responsibility to disclose important health information to the lead trainer.

By clicking "I agree" I hereby attest that all information provided is correct. I also agree to adhere to the terms set forth by Glowing Body Yoga Studio.*

I agree