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First Name:
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Last Name:
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Address:
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City:
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State:
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Zip:
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Phone:
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Email:
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List
all medical injuries/illnesses:
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Emergency Contact:
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Emergency Contact Phone:
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How
long have you been practicing Yoga?:
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How
many times a week do you practice Yoga?:
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What
styles of Yoga have you studied?:
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Who
have your main teachers or biggest influences been?:
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| Do
you have a personal yoga practice now?:
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What
does it include?:
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| Do you practice
Pranayama on a regular basis?:
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| Do you meditate
on a regular basis?:
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If so, What style,
and how often?:
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| Have you taken
any previous yoga teacher’s trainings?:
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If so, when and
where?:
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| Do you currently
teach?:
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If so, where?:
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| If no, do you plan
to teach?:
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If not, why?:
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Please list any other
trainings, experiences, healing modalities that you
practice,
which might be relevent to yoga (i.e. -martial arts, dance, ect.):
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What would you
like to gain from this training?:
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Please describe
a yoga or life influence:
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Describe a life
challenge and how you overcame it:
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How has Yoga changed
your life?:
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Please list anything else
you would like us to know, or questions you
might have about the training:
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