Bindu Yoga Studio Del Mar Village

Personal Information

Name First Last
Birthdate / MM / DD YYYY
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Cell - (###) - ### ####
Address
Street Address

Address Line 2

City

State / Province / Region

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Emergency Contact

First Last
Emergency Contact Phone - (###) - ### ####
Relationship:

Medical History

Please complete the medical history section so that we can be sure to respond to any emergencies should they arise during your training. Please note that none of your responses would exclude you from being accepted into the program.

How would you evaluate your current health? Excellent Good Fair Some challenges (briefly describe)
Briefly describe your challenges
Do you suffer from any of the conditions below? Epilepsy Diabetes High-blood Pressure Pregnant, plan to become pregnant during the course of the training No, I do not suffer from the above conditions to my knowledge
Please list medications you are taking that were prescribed to you by a health care professional:
Is there anything else we should know about your medical history?

About You

How long have you been practicing yoga?
How many days per week do you practice yoga?
What style of yoga do you usually practice?
At which yoga studios do you currently practice?
Who have been your primary teachers?
Do you have a home practice? Yes No
Do you practice meditation and/or pranayama? Yes No
Do you practice inversions? Yes No
Do you practice Sun Salutations A & B? Yes No
Do you practice chaturanga/vinyasas? Yes No
Is this your first teacher training? Yes No
If this is not your first training, please list prior training:
Are you currently teaching yoga? Yes No
If yes, for how many years? Where do you teach?
Which area of yoga challenges you the most? (Please specify)
In your opinion, what qualities embody a good yoga teacher? Why?
Why do you want to take the Bindu Yoga Teacher Training program? What specifically interests you?
Please list pertinent workshops, trainings, intensives and/or retreats:
How has yoga impacted your life?
What are your expectations for this training? What do you hope to achieve at the completion of the program?
Can you commit to the entire course? Being on time for every session? Yes No
If no, please explain:
Credit Card Type Visa Mastercard

CERTIFICATE OF COMPLETION:

Upon successful completion of the entire course, you will be issued a certificate of completion. This is not awarded solely based on hours or subjects completed; it is also determined by the teacher's assessment of the student's grasp of concepts and materials presented. A written final examination must be completed and passed to receive the Certificate of Completion

Payment Information

A $500 non-refundable deposit is due upon acceptance. Full payment is required no later than the start of the program. Your card will only be charged upon acceptance into the Teacher Training Program.

Credit Card #
Exp. Date
Name as it appears on the card: First Last
Billing Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
If I am accepted into this program, I hereby authorize non-refundable payment of $500 to Bindu Yoga Studio. Yes No

PLEASE READ AND SIGN BELOW TO COMPLETE YOUR APPLICATION

I understand that if I fulfill all the requirements of the Bindu Yoga Studio Teacher Training, including all in-class hours, homework, quizzes and final exam, I will receive a certificate of completion, which can be submitted to the Yoga Alliance or a prospective employer as evidence that I have completed a 200-hour Teacher Training program.

I understand that if I am late for or miss a teacher training session, I will not receive credit for the session and am therefore ineligible to receive a certificate of completion which may be submitted for Yoga Alliance Registration.

I understand that Bindu Yoga Studio reserves the right to ask me to leave the program if my behavior is inappropriate, unethical or violates the Yoga Alliance ethical guidelines. Under such circumstances, I understand I will not be refunded my tuition.

I understand that if I cancel my enrollment up to 30 days prior to the training, a refund will be issued minus the deposit and the cost of any books or other materials ordered for me. I will receive any materials you have paid for, except for the training manual. For cancellations in the 30 days prior to the training, I will receive a credit at the studio for the full amount, minus the deposit and materials fees. Once the program begins, tuition is non-refundable and non-transferable.

I understand that all Bindu Yoga Studio Teacher Training materials are under copyright protection and cannot be reproduced by me without the permission of Gina Caputo. Failure to comply may result in legal action.

I have read and accept the above terms and requirements: Yes No
Signed:
Full Name

Bindu Yoga Studio in Del Mar