300 Hour Advanced Yoga Certification Program Application

300 Hour Yoga Certification Application

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Please indicate street address, city, state and zip.

Please describe your background in yoga.

Do you have a background teaching Yoga and / or other teaching experience? Please describe.

Are you currently teaching Yoga? If so, number of classes per week? What traditions, styles and for how long?

What does Yoga mean to you, and how has it affected your life?

Why do you want to take this training? What are your expectations of it and how will you utilize your Certification?

Where did you receive your 200 hour? Are you registered with RYA?

In your opinion what does a Yoga teacher provide for his/her students? What would you like to be able to provide to your students as a Yoga teacher?

HEALTH INFORMATION FORM & WAIVER
Are you currently under medical treatment or supervision? If yes, please describe.

Are there any health concerns that Whitman Wellness Center should be aware? If so, please describe.

DECLARATION OF DISCLOSURE & ACCEPTANCE OF TERMS
I hereby declare the above information is true to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for revocation of Certification. I have enrolled in a Teacher Training Program of physical activity including, but not limited to various yoga and meditation exercises offered by Whitman Wellness Center. I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in this exercise program. I release Whitman Wellness Center from any liability now, or in the future, including but no limited to: heart attacks, muscle strains, pulls, tears and broken bones, shin splints, heat prostration, knee, lower back or foot injuries and any other illness, soreness or injury, however caused, occurring during or after my participation in this program.

I understand that I am entitled to no refunds, credits or adjustments resulting from my failure to complete the certification requirements or to uphold any of these conditions.

Please write your name to confirm your understanding of the Declaration of Disclosure and Acceptance of Terms.

Please use this area to provide any additional information, if necessary.