GREEN TREE SCHOOL OF YOGA STUDENT APPLICATION

Please complete the following application.  Please use pen and print this form.  Please answer the questions honestly on a separate page (type or write neatly). One paragraph is sufficient, keep in mind there are not right or wrong answers.  Please return with application fee, make check out to “Green Tree Yoga School” in the amount of $10.00.  Mail to: PO Box 942,  South Bend, IN  46624  

NAME:__________________________________________________________

TODAY’S DATE:________________    DATE OF BIRTH:__________________

STREET ADDRESS:_______________________________________________

City:_____________________________  STATE:_______  ZIP:___________

PHONE NUMBERS:  Home:__________________________________________

Cell:____________________________  Other: _________________________

EMERGENCY CONTACT INFORMATION:

Name _______________________________ Number ____________________

Other numbers ______________________________________________________

What is the role of yoga in your life?  How long have you been practicing yoga?  Describe your yoga practice.  Do you take classes?  With whom and in what style?

 

Why are you interested in taking this program?  Do you intend to teach or are you currently teaching?  What are your primary interests in the practice of yoga?

 

Describe your other life commitments and how you plan to create time for attending the program sessions, completing the assignments and the daily practice requirement.

 

Are you presently receiving medical or psychiatric care?  Do you have any physical or psychological considerations that may effect your participation in this program?  Describe any concerns you have about your participation in this program.

kim@sagewateryoga.com * 574-233-1075 or 574-360-1401 * PO Box 942, South Bend, IN 46624