21CYM Yoga Teacher Training ApplicationWelcome to the First Step of the Journey! Name * First Name Last Name Email * Date of Training Start * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Medical History Please complete so that we can handle potential emergencies and address any contraindications. Answers will not exclude you from the program and will be kept confidential. How would you evaluate your current health? * Excellent Good Fair Some Challenges If you have some challenges, please describe: Do you have any of the conditions listed below? * Epilepsy Diabetes None of the Above Are you pregnant or do you plan to become pregnant during the course of the training? Yes No Within the past two years, have you been under the care of a physician or mental health care professional? Yes No Please List Medications You are taking prescribed by your physician or mental health care professional: * Enter Any Other Health / Injury Concern What is your current Training Certification Plan? (dates you plan to attend training / date you plan to be certified) Are You Over 21 Years Old? Yes No How did you find out about us? You will also need to submit a 1 to 3 page Application Letter: Directions will be sent to your email address after you push the button below to Apply to the Training. Your Application Letter is your statement about where you are at on your yoga path. Who are you? .... as a person? .... as a yogi? .... and what brings you to Yoga Teacher Training? We recommend having completed this letter before submitting your application. You will be sent instructions on how to submit your letter after pushing the "Apply to Training" button below. Primary Phone Number * (###) ### #### Thank you for your application! You should have an email immediately in your inbox. Please check your spam/junk folder to make sure that you are not missing emails!