Ananda Yoga Teacher Training Application

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Emergency Contact Name & Phone Number(Required)

Please provide an emergency contact name and phone number

Please tell us about your yoga practice(Required)

How long have you been practicing yoga?

What Traditions or Styles of Yoga have you practice?

How often do you practice yoga?(Required)

Do you practice meditation regularly?

What do you expect out of the program?

Please describe what you hope to gain from Ananda Yoga Teacher Training. When possible, please be specific in your description. This will help us serve you better during the program.

MEDICAL INFORMATION

All responses are confidential. We use this information only to better assist you during the program, not to screen participants (unless participation would be medically inadvisable).

Briefly describe your current overall health.

Describe any history (include dates) of back/spine/neck problems, and indicate whether they still give you problems. Please be specific.

Describe any history (include dates) of joint problems (knee, hip, shoulder, wrist, ankle, etc.), including joint repair/replacement surgeries. Please be specific.

Blood Pressure(Required)

Normal

High

Low

When was your blood pressure last checked?

Describe any history of cardiovascular problems. If you don’t have any cardiovascular problems but are considered to be “at risk”, then please indicate this as well.

Have you been diagnosed with any of the following conditions? Please check all that apply.

Are you currently seeing a physician or a therapist for any physical or psychological conditions?

If yes, what conditions?

For Women – Are you Pregnant?

Yes

If Yes, when is your baby due?

Do you have any other limitations, dietary restrictions, or health concerns? If so, please explain.

Are you taking medication for any physical or psychological conditions? Yes / No. If yes, then what medications are taken for which conditions and at what frequency?

If you have any learning disabilities, or other special physical or psychological circumstance, please explain below so we can better serve you during the program.

Date(Required)

Ananda Yoga Teacher Training Application

Program Highlights

More Information

How to Apply

Yoga Teacher Training – Level 1 Application

MEDICAL INFORMATION

All responses are confidential. We use this information only to better assist you during the program, not to screen participants (unless participation would be medically inadvisable).