yoga Part
Yoga Part
Application Form
Note: This is a formal application form for those interested in joining the program. If you are only making an informal enquiry, then please use the contact form instead.
Personal Information :
 
Choose Course Date  
First & Last Name :  
Gender :  

Address :

 
City & State/Province :  

Country :

 

Zip Code/Postal Code :

 

Email :

 

Phone  Number :

 

Current Occupation/ Profession :

 
Birth Date (DD/MM/YY) :  
Your Height :  
Your Weight :  
Language(s) Spoken:  
How did you hear about Ajarya :  
Emergency Contact:
Name:  

Phone Number:

 

Your Relationship with contact:

 

Email (of emergency contact):

 
Yoga Experience :
How long have you been practicing Yoga :  
Why do you do OR wish to do Yoga?  
Why would you like to take this training course?    
Other Comments  
Would you like to receive future
updates from Ajarya
Yes No  
Health Information :
The following questions are here to help us provide each student with the necessary means to make the teacher training experience enjoyable for all.  The answers to these questions will be kept in strict confidence, and may be discussed with the applicant to make sure that the teacher training program is the right choice for them.
     
Are you currently taking medication for any physical or psychological condition? Yes No
Do you have any chronic physical limitations or disabilities? Yes No
Do you have a history of psychological or emotional illnesses, or issues? Yes No
Do you have a communicable disease? Yes No
Have you had a serious illness or major surgery within the last five years? Yes No
Are you currently pregnant or trying to become pregnant? Yes No
   
If you answered YES to any of the above questions, please provide us with more relevant details as it would pertain to the teacher training program. As well, please describe if there is anything else you feel we should know with regards to your participation in the program here:
   
Security Code Enter Code
     
  By submitting this Application form, you agree to the
Terms & Conditions of participation