Teacher Training Application

Please Select The Teacher Training You Are Applying For

1. PERSONAL INFORMATION

First Name:
Last Name:
Gender:
Date & Time of Birth:
Place of Birth:
Cell Phone Number:

E-Mail Address:
Skype Username:
Street Address:
City:
Country:


Please upload a recent photo here. This helps us put your face to your name during the emailing process.


2. YOGA PRACTICE INFORMATION

What style(s) of Yoga do you practice regularly?

How long is your daily practice (in hours)?

Approximately what year did you start to practice and/or teach Yoga?

Please provide the names of your principal teachers or schools

Are you a yoga teacher?

How many hours do you teach per week?

What style(s) of Hatha-Yoga do you teach?

If you meditate, how long have you been meditating, and how often do you meditate?

3. HEALTH INFORMATION (Confidential)

If you are under medical treatment or supervision, please tell us about it as thoroughly as you can.

If you are pregnant, when is your due date?

If you are currently receiving psychotherapy, psychiatric treatment, and/or counseling, please tell us about the history and processes you are using currently.

If you have ever been hospitalized or received psychiatric treatment, when did this occur and for which condition(s)?

If you have had a recent history of fatigue, emotional collapse, or major trauma please tell us about your experience and where you are in your recovery.

If you have any chronic physical impairment (e.g., vision, hearing, movement, etc.), what is the nature and extent of your health challenges?

Do you have any communicable diseases?

Which disease or diseases?

During the past three years have you been addicted to drugs or alcohol?

Please provide an overview of this condition:

If you are using any prescription medication, please indicate type, dosage, and frequency of intake.

4. EMERGENCY CONTACTS

Contact Name:
Contact Phone:

Physician Name:
Physician Phone:

Therapist Name:
Therapist Phone:

5. ADDITIONAL INFORMATION

How did you learn about Swara Yoga teacher training program?
(Thank you for indicating all applicable.)

Swara Contact Person:
Website:
Media/Ad:
Family/Friend/Care Provider:
Please Describe:

How else did you hear about Swara Yoga teacher training program?

Swara Contact Person:
Website:
Media/Ad:
Family/Friend/Care Provider:
Please Describe:

6. DECLARATION OF DISCLOSURE AND ACCEPTANCE OF TERMS

I hereby declare that the above information is true to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for rejecting this application, expulsion from the program, or revocation of certification. I understand that I am entitled to no refunds, credits, or adjustments resulting from my failure to uphold any of these conditions.


I understand and agree

7. REFUND POLICY

I understand and agree that I must notify Swara Yoga of cancellation within 14 days of my initial purchase in order to receive a full refund, minus the deposit and registration fee. Within 14 days of the start, no refund or credit will be given if I cannot attend. Once the Training begins, no refund or credit will be given. The deposit and registration are non-refundable.


I understand and agree

8. SIGNATURE

By applying to this training program you agree to comply with these terms. Your signature below acknowledges your agreement with this policy.


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