Full Name

Address

Email Address

PRIMARY PHONE

SECONDARY PHONE

WHAT IS YOUR GENDER or PREFERRED PRONOUN?

WHAT IS YOUR BIRTHDAY? (ex. 01/01/00)

Emergency Contact

Relationship

Cell phone

WHAT ARE YOUR OTHER INTERESTS OUTSIDE OF YOGA?:

DESCRIBE ANY INJURIES, LIMITATIONS, CHALLENGES, DISABILITIES, OR ILLNESSES WE SHOULD BE AWARE OF AND WHAT TREATMENTS ARE YOU EMPLOYING TO ADDRESS THESE:

HOW LONG HAVE YOU PRACTICED YOGA? PLEASE DESCRIBE YOUR PRACTICE AND ITS CONSISTENCY:

DO YOU CURRENTLY TEACH YOGA?

DO YOU HOLD ANY OTHER YOGA CERTIFICATIONS? IF YES, PLEASE DESCRIBE:

WHAT IS YOUR PROFESSION?:

DO YOU PLAN TO TEACH YOGA ONCE YOU ARE CERTIFIED?:

WHY DO YOU WANT TO TAKE THIS TRAINING? WHAT ARE YOU HOPING TO GAIN FROM THIS TRAINING?:

WHAT DO YOU LIKE ABOUT YOGA?:

WHAT CAN YOU DO NOW THAT YOU COULDN'T DO A YEAR AGO?:

WHO/WHAT INSPIRES YOU?:

WHAT IS ONE OF YOUR FAVORITE FAILURES? WHAT DID IT TEACH YOU?:

I am the individual given above. I am the individual given above. I confirm that all information provided herein is true, accurate and up to date. Further, I agree that to the extent that there are any changes to the information provided above that may affect my ability to attend the Teacher Training, I shall inform Day Christensen as soon as possible hereof. I understand and agree that any and all information I submit will be sent to the host studio, Day Christensen for the purposes of registration and application and graduation for the training in question. In addition, I confirm that I have read, understood and agreed to the payment and refund terms.

Applicant Name

Date (ex. 01/01/00)