200hr Teacher Training Application Form - Gertrude Street Yoga Studio

Personal Details
Name*
First Last
Preferred Name and Spelling for Certificate*
Email*
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Emergency Contact Details
Emergency Contact*
First Last
Emergency Contact Email*
Emergency Contact Phone*

About You
Education and Training*
Please list your education and trainings (related and unrelated to yoga)
Profession*
What do you currently do for work?
Something Unique*
Please share something unique about yourself!

How did you hear about this training?*
Who recommended it?
What made you choose this training? What appealed to you?*
What is your primary motivation for taking this training? Do you want to teach?*

Health and Wellness
Do you have any current physical, emotional, or mental health concerns that might affect your participation in this training?*
- Yes
- No
Please describe any current concerns.*
Do you have any health or wellness concerns that might affect your participation in our Bali Retreat?*
- Yes
- No
Please describe any concerns regarding Bali.*
Please share any history of trauma, anxiety, depression, or other health concerns so that we have a clear understanding of your background and are best equipped to support you through this training.*
Do you have any allergies?*
- Yes
- No
Please list your allergies*
Are you currently taking any medication?*
- Yes
- No
Please list your medications*
What is your level of oral and written proficiency in english?*

Payment Details
Select a Training*
- February 2019
- June 2019
Pricing*
Are you applying for the $500 scholarship?*
- Yes
- No
Please share what the scholarship would mean to you
Agreements
*
- I understand that 1+ year of experience practicing yoga is recommended before attending this training
*
- I understand that once my application has been accepted my deposit is non refundable
*
- I understand that I must make my deposit before my application will be processed
*
- I understand that missing more than 3 days may result in loss of certification
Cancellation Policy*
30+ days before course start date: 100% refund (minus the $500 deposit) 20-30 days before the course start date: 50% refund (minus $500 deposit) 10-20 days before the course start date: 25% refund (minus $500 deposit) 0 – 10 days before the course start date: No refund If for some reason you are unable to complete the course once you have started we will find the best course of action on a case by case basis.
- I have read and agree to the cancellation policy
Photo*
Please upload a headshot of yourself

Personal Details