YOGIFY YOUR LIFE!
200-hour Yoga Teacher Training
Student Application Form

Course Date: —Please choose an option—May 1 – 27, 2023100 YTT: June 12 - 22, 2023July 3 – 29, 2023September 11 – October 7, 2023April 1 – 27, 2024May 6 – June 1, 2024100 YTT: June 3 – 13, 2024July 1 – 27, 2024August 5 – 31, 2024October 14 – November 9, 2024

YTT Course Package Preference: —Please choose an option—YTT PackageYTT Package including Accommodation

Full Name:

Preferred name:

Email:

Phone Number:

Gender: —Please choose an option—FemaleMaleNon-binary

Date of Birth (DD/MM/YYYY):

Current occupation:

Nationality / Citizenship:

Passport Number:

Address:

City:

ZIP / Postal Code:

Country:

Facebook / Instagram account name?

How did you hear about us?(If online, please specify the exact website?)

Do you have any food allergies?

Do you have any physical limitations/injuries that may prevent you from an extensive asana practice or for sitting for extended periods of time? If yes, please describe:

How frequently do you practice yoga (daily, weekly, monthly)?

Are you currently taking any form of medication?

How long have you been practicing yoga? Please explain experience and styles of yoga explored.

What do you hope to get out of this immersion/teacher training? Please list the 3 primary things.

Is there anything else it would be helpful for us to know about you or your past? (e.g. social therapy, anxiety issues, etc)

Have you got any fears or apprehensions about the upcoming training?

At Loka Yoga we serve vegetarian food, and we encourage you to explore that diet with us. Y/N? If no, please advise us why?

Do you have any specific food requests? Please know that we will do our best to cater for you, but depending on the request, it may not be possible.

Have you ever received professional medical treatment due to any psychological condition?

EMERGENCY CONTACT - Full name:

EMERGENCY CONTACT - Relationship to you:

EMERGENCY CONTACT - Email address:

EMERGENCY CONTACT - Contact phone number (please include country code):

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