Your Name (required)

    Your Email (required)

    Name as you would like it to appear on the certificate (required)

    Address (required)

    Contact Phone (required)

    DOB YYYY-MM-DD (required)



    T-Shirt Size


    Occupation (required)

    Education and Special Skills

    Emergency Contact (required)

    Emergency Contact Relationship (required)

    Emergency Contact Phone (required)

    Have you ever been convicted of a crime? (If yes, we will contact you to further discuss the circumstances.) (required)

    How long have you been practicing yoga? (required)

    Please describe your yoga practice (this may include asana, pranayama, meditation, or any other reqular practice that is yoga for you.)

    If you have practiced yoga for less than one year, please describe other movement, breathing, mindfulness, or spiritual practices that you have experience with that will support your development of a yoga practice. Please explain why you feel you should be considered for this training.

    What does yoga mean to you? (required)

    Other than certification, what do you hope to learn from this Yoga Teaching Training?

    If you intend to become a yoga instructor, describe your vision upon completion of this training.

    Is there anything else that you would like us to know about you?

    By submitting this application I agree that I am physically and emotionally fit to complete this course of study. I agree that throughout the course of the program I will treat the space, other students, instructors, and clients at the YMCA with respect and will respect their confidentiality in and outside of the training regarding any personal information. Enter your full name as indication of your agreement to the above statement. (required)

    Signature Date YYYY-MM-DD (required)