To apply to the Essential Yoga Studio Teacher Training Program, please complete the following application and mail it, along with your $250 deposit to: Essential Yoga Studio 5738 Robinson Rd Fernie, BC V0B-1M4. Or fax application to 250-423-7867. If you have any questions, please contact us at 250-423-9672
Name:................................................................................................. o Male o Female Age.............
SIN # or Social Security Number .........................................................................
Date of Birth...............................................................................................................................................
Emergency contact (name and telephone)..................................................................................................
How did you hear about our Teacher Training program?
Please answer all questions to the best of your ability
1.
Please list any previous yoga experience (length of time, specific teachers, types of yoga)
2.
Please List any NON-Yoga personal growth, transformational based courses, workshops, seminars or retreats you have completed.
3.
Why are you interested in this Teacher Training Program?
4.
What are your expectations for this training? What do you hope to gain, learn, or work on?
6.
List any other interesting things you think we should know about you.
7.
Do you already teach?
Physical Health Please note that this section of the application is mandatory. Please be accurate and honest
How would you evaluate your current health?
Excellent
Good
Fair
Some Challenge
Are you currently, or during the last two years have you been under the care of a physician or other health care professional?
Yes No
If Yes, for what reason?
Do you have epilepsy?
Yes No
Do you have diabetes?
Yes No
List the health care professional's name, specialty and address:
Name:
Specialty:
Address:
Please list any medications you are currently taking or have taken in the last year that were prescribed by a health care professional:
Are you currently, or during the last two years have you been, under the care or supervision of a mental health professional(psychiatrist, therapist, etc.)?
Yes No
If yes, for what condition?
Please list any medications you are currently taking that were prescribed to you by a health professional:
Have you been hospitalized in the past year?
Yes No
If yes, for what condition?:
Do you have any special dietary requirements? If yes, please list:
Do you currently suffer from an eating or exercise disorder, or have you been treated for an eating or exercise disorder in the past? Please explain.
Do you have any challenges in participating in any physical activities?
Yes No
If yes, please list:
Do you smoke?
Yes No
Do you drink alcohol?
Yes No
If yes, how much and how often?
Do you use drugs?
Yes No
If yes, how much and how often?
Please describe any current or past health issues you have had:
The cost of the program:
$250 Registration Fee,Foundation Module $1500,Transitional Module $1200, or $295/weekend with an additional 20 hours of hands-on teaching and observing at EYS $500
We accept Visa or Cheque
Please mark the following program(s )you will be attending:
Teacher Training of Your Choice:
Intensive Weekend Program
The program fees are subject to cost change.
POLICIES
Fees can be made in one payment or paid out over several months prior to attending.
All tuition fees must be paid 31 days before you attend the 10-day intensive. If we have not received your fees by that time, and no other prior arrangements have been made with us, your slot at the intensive could be forfeited. There are no refunds unless cancellation occurs 15 days prior to the beginning of the course start date.
Calculate Total Program Fees
Non-refundable deposit $250
Essential Yoga Studio Program fee
Foundation Module________
Transitional Module________
Weekend Program_________
On-Site Learning__________
TOTAL Cheque _________
to Essential Yoga Studio
Visa _____________
Amount to Charge at this time $_____________
(The entire amount due will be charged 31 days prior to entry unless other arrangements were made)
Payment Method
o Check or Money Order payable to Essential Yoga Studio.
Student: I have received a copy of this enrollment agreement which contains the Refund Policy.
Your name:.........................................................................................................................................................................................................................
Your telephone number:.................................................................................................................................................................................................
Your signature: .................................................... Date of Signature:
Signature of Essential Yoga Studio Program Representative:..............................................................................................................................................
