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Application for Teacher Training Program 200 Hour Certification

This application must be submitted and approved prior to taking the course. Please complete and return this application to:

McIntosh Yoga, P.0. Box 799, McIntosh, Florida 32664

Phone number 352-591-5739 or email application to neilwc68@gmail.com.

Once you have been approved, a registration form will be sent to you.

Personal Information will NOT be shared

Name ______________________________________ Address____________________________________ Home phone _____________________ Cell phone _______________________ email ____________________ Occupation ___________________________ Date of birth _______________________

How long have you been practicing yoga?________________________________________

How frequently do you practice?________________________________________________

Where do you currently practice?_______________________________________________

Do you meditate? ____Yes ____No. If yes, please describe your practice. Please use an additional page for describing your meditation practice.

Why do you want to be a teacher? Use back of this page or add an additional page.

Do you have any physical limitations, injuries, or other conditions that might prevent you from participating fully in this program? Yes _____ No ______ If yes, please describe:

I understand that yoga teacher training is rigorous and demanding of my time and effort. I understand that the practice of yoga is about exploring new boundaries and limits which may involve exploring and discussing different belief systems, which may be different from my own. I understand that there will be time during the program when people may speak relevant thoughts, questions, feelings and insights. I will monitor what is safe and right for me and I will commit myself, to the best of my ability, to the teacher training program.

Applicant's Signature _______________________________________

Date _______________