Intouch Yoga Intouch Yoga Level 1 200 Hour Teacher Training Application Form

Flo Fenton
Intouch Yoga Byron Bay
8/6 Firewheel Court
Suffolk Park
NSW 2481
Australia


Email: flo@intouchyogabyronbay.com


Please note that all information gathered is strictly confidential, and will be shared only with Intouch Yoga teaching staff as needed.

Personal Details

Full Name

*

Gender

*

Date of Birth

Occupation

Postal Address

Email

*

Training Name

*

Training Date

*

Phone Number (Home)

Phone Number (Mobile)

Emergency Contact Person

Emergency Contact Number

Passport Type

(Foreign Students only)

Passport Number

Do you have a minimum level of English language proficiency, both written and oral?

Health and Fitness

Do you have any physical health conditions?

Have you had any surgery?

*

Do you have any physical injuries?

Are you taking any medication?

Do you smoke or drink or take other recreational drugs?

(Please indicate quantity, whether daily use, and length of time this has occurred.)
NOTE; there is no discrimination implied, and these questions are only used in a confidential manner, and to aid our over- all health assessment.

What is your level of physical fitness?

*

What is your blood pressure?

(if known)

Mental and Emotional Health

Do you suffer from any form of mental illness or emotional instability (including confusion, anger and or depression, eating disorder?)

Have you ever received treatment for your mental health, and if so what is/was it?

Have you ever spent time in a meditation retreat, or do you have a regular meditation practice?

Yoga Experience and Practice

What style of Yoga do you practice? How long have you been practicing?

Do you have a self-practice? (If so please detail including length, frequency and content)

Do you attend regular classes? What style, how often, and with whom?

Are you currently teaching? If so where and how often?

What areas of your yoga practice do you have difficulty with?

What do you aim to achieve from completing this course?

Please list any yoga related qualifications you have, or any retreats/courses attended with other teachers.

Thank you for completing this questionnaire.

The answers to your questions help us to gauge your readiness for this course, and to assist you in your journey. Please note that completion of this questionnaire does not guarantee you a place on the course.
You will be notified as to your acceptance. Once you are accepted into the course you will be required to sign a disclaimer form, and pay your non-refundable deposit. On receipt of your deposit your place will be secured.

Declaration

**

I declare I have disclosed on this form all relevant details and by submitting these details to Intouch Yoga I take full responsibility for myself in attending this course.

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