YTT Intake form

Trainee Intake Form

* Indicates required field

Name *

DOB (DD/MM/YY) *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact ( Name / Phone) *

Occupation *

Hobbies/Activities/Interests *

Are there any weekends or sessions you are unable to attend? If so please list below *

Are there any accommodations or support you may need in order to feel supported in this learning environment? *

How often do you practice yoga? *

Nearly everyday 2-4 times per week Once per week A few times per month

If other please specify *

What styles of yoga do you normally practice? (Check all that apply) *

Ashtanga Vinyasa Flow Restorative/Gentle Yin Iyengar Power/Hot Bikram/Hot Hatha/Strong

What are your interests regarding yoga? (Check all that apply) *

Asana (Physical Practice) Pranayama Meditation Yoga Philosophy Energetic Anatomy (Subtle Body, Chakras/Etc) Physical Anatomy

What is your current level of fitness *

Very Inactive Fairly Inactive Average Fairly Active Very Active

On a scale from 1- 10 (1 being the lowest) how would you rate your level of stress? *

What activities or actions do you do daily that could benefit from more flexibility or strength? *

Daily work or leisure activities/ sports or other exercises

What activities or strategies, if any, do you utilize to combat stress? *

SUBMIT