Name

City

Country

Email Address

Phone

Gender GenderMaleFemaleOther

Date of Birth

Occupation

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

How did you hear about this training?

How long have you been practicing yoga? How often do you practice?

What styles of yoga have you been practicing? Where and which teachers have you been practicing with?

What do you hope to learn, gain and transform about yourself? Why do you want to teach yoga?

What are your expectations for this training?

Do you have any physical injuries, psychological or medical conditions we should know about?

List other interesting things you think we should know about you.

Agree to Terms & Conditions Agree to Terms & Conditions By checking this box, I declare that I have read and understand the entire application and agree to the terms and conditions of undertaking this program with Om Yoga Studio. The facts set forth in this application are, to the best of my knowledge, true and complete. *Terms & Conditions: 1)Refund Policy: For cancellation one month prior to the start date of the purchased module, payment will be refunded less $500 application fee. Less than one month prior to and up to the day before training begins, 25% of the teacher training cost will be refunded. There is NO refund once training begins. For full payment of 300 hours, NO refund once the first training with us begins. 2)Non-Disclosure Clause: All information whether it be shared, written, discussed at the training regarding students, teachers, training or policy is considered confidential and shall not be disclosed in whole or in part by you to any person without prior written consent. Violation of any part of this policy will result in immediate termination of this course with the trainee forfeiting all paid fees. 3)Permission to Use Photographs and Footage: In signing this agreement you agree to allow Om Yoga Studio to use photographs and video footage in publications and promotional materials for print publications or website.