2015 Teacher Training Application

Fall 2016 Teacher Training Application

Yoga Loft 200-Hour Certification Program

To reserve your place in the Yoga Loft Teacher Training, please complete this form and submit with a $500 non-refundable deposit. To receive early bird savings of $300, deposit must be received by 6/14/16. 200 HOUR CERTIFICATION: $2500 Early Bird Special (through 6/14): $2200 Optional Payment Plan of $400 per month for 6 months Unlimited yoga is included throughout the training! Current Yoga Loft members may put their monthly membership on a temporary 6 month hold.

PERSONAL INFORMATION

FIRST NAME

LAST NAME

STREET ADDRESS

STREET ADDRESS LINE 2

CITY

STATE

ZIP CODE

PHONE NUMBER

EMAIL ADDRESS

EMERGENCY CONTACT

RELATIONSHIP

Phone Number

Is there someone we can thank for referring you?

We would like to know more about you! What inspires you to participate in this Yoga Loft Teacher Training? What are your goals? What expectations do you have? If more space is needed, use additional paper or expand the box.

2016 TRAINING SCHEDULEPart 1: Immersion Deepening Your Yoga PracticeSession 1: AUG 26-28 @9AM-6PMSession 2: SEPT 9-11 @9AM-6PMSession 3: SEPT 23-25 @9AM-6PM Part 2: Sharing Your Yoga PracticeSession 4: OCT 7-9 @9AM-6PMSession 5: OCT 28-30 @9AM-6PMSession 6: NOV 18-22 @9AM-6PMSession 7: Optional Children's Yoga Teacher Certification DEC 2-4

MEDICAL HISTORY Your health and safety are most important to us. Please complete the medical history section below so that we can best respond to any emergencies should they arise during your training. Please note that at any time your teacher(s) may ask you to sit out or leave if your physical and/or mental health adversely safely participate, or if you are affecting the safety and learning of others.

Please detail any injuries, medical conditions, recent surgeries, etc. in the space below.

ABOUT YOU

Is there any teacher or philosophy that has had a significant impact on your practice?

How long have you been practicing yoga?

On average, how many days per week do you practice yoga?

What style of yoga do you usually practice?

Check this box if you are currently teaching yoga

If you checked the box to the left, where do you currently teach yoga?

How will you know this program is/was a success for you?

PAYMENT INFORMATION$500 deposit is due with your application (located at the bottom of the form). Full payment is required prior to the final weekend of the Teacher Training Program. To receive "early-bird special" pricing, $500 deposit and application is due by 6/14/16.

PROGRAM PARTICIPATION AGREEMENTI understand that if I am paid in full and fulfill all the requirements of Yoga Loft Teacher Training, including in-class hours, homework, quizzes and passing both written and in-class final exams, I will receive a certificate of completion, which can be submitted to the Yoga Alliance or prospective employers as evidence that I have completed a 200-hour Teacher Training Program. I also understand that paying for the teacher training and completing the hours alone does not mean I will pass the teacher training. Students must pass all of the components of the program to the satisfaction of the school in order to graduate. I understand that Yoga Loft reserves the right to ask me to leave the program, without refunded tuition, if I am found if my behavior is unethical, disruptive, inappropriate, or negatively impacts the learning of other participants. Students are required to follow the widely accepted Yoga Alliance Code of Conduct which can be found at www.yogaalliance.org. I understand that Yoga Loft reserves the right at anytime to ask me to leave the training if it appears that my health or physical practice are not at the level to fully participate in the training. Under such circumstances, and any and all other circumstances that result in my leaving the training prior to completion, I understand that I will be given a prorated refund, based on the amount of time I have attended in the training. I understand that if I miss over 40 hours I will receive a non-passing status and will be asked to leave the training. Under such circumstances, I understand I will be given the opportunity to retake the program at a discounted rate. I understand that if I am habitually tardy, I will not receive credit for the days I am tardy. I understand that practice and teaching of yoga includes physical, spiritual and emotional components and that these components will be included in this program either directly through discussion or indirectly as the need may arise.

I understand that if I cancel 14 days prior to the start of the training, my deposit may be transferred toward a future Teacher Training and I will be refunded my remaining balance. If I cancel within 14 days before the start of the training, I will forfeit my $500 deposit but my remaining balance will be refunded. Once the program begins, tuition is non-refundable and non-transferable. I understand that all Yoga Loft Teacher Training materials are under copyright protection and cannot be reproduced by me without the permission of Yoga Loft owners.

ASSUMPTION OF RISK, HEALTH WARRANTYYoga is an individual experience and I understand that I should progress at my own pace while participating in the physical active portions of the Yoga Loft"s 200-Hour Teacher Training Program. If at any point I feel overexertion or fatigue, I will respect my own body"s limitations and I will rest before continuing Yoga or any other exercise. I acknowledge that participating in the Yoga Loft"s 200-Hour Teacher Training program naturally involves the risk of injury to me. I further acknowledge that specific risks include injuries resulting from over-exertion, physical adjustment, improper or negligent use of equipment, failure to follow trainer instructions, or injuries resulting from participation in an inappropriate level of physical exercise. As such, I understand and voluntarily accept these risks. I represent that I am in good health, at least 18 years of age, have the necessary current medical approval to engage in physical exercise and yoga instructional classes and teacher training and have no disability, impairment, injury, disease or ailment which would cause risk of injury or adverse health consequences as a result of engaging in physical exercise and yoga instructional classes and teacher training. I acknowledge that to the facility where I am taking my training and Yoga Loft are relying on this representation and I understand that Yoga Loft will not investigate or certify my health or my fitness to participate in the physical exercise and yoga instructional classes and teacher training.

RELEASE AND WAIVER OF LIABILITY: In consideration for my participation in Yoga Loft"s Teacher Training and Immersion Program, I, individually, and behalf of my relatives, legal representatives, and assigns, agree not to sue and hereby agree to defend, indemnify, release and hold harmless to the facility where I am taking my training and Yoga Loft and each of their respective shareholders, owners, officers, directors, members, employees, contractors and agents, and the owner of the facility where the 200-hour Teacher Training Program occurs (collectively, the "Releasees") from all actions, claims, demands, suits, losses, liabilities, charges, expenses (including, without limitation, attorneys" fees), and costs of any nature whatsoever which may arise out of, relate to, or result from, any injury, economic loss or any damage to me or my guest or relatives resulting from m participation in physical exercise and yoga instructional classes and teacher training on Yoga Loft"s behalf or anyone using the Facility or Yoga Loft"s equipment, facilities or services, except such as may arise of the gross negligence or willful misconduct of the Releasees. This release and waiver of liability ("this Release") is intended to be a complete release of any responsibility for personal injuries and/or property loss/damage sustained by me while at the Yoga Loft, whether using exercise equipment, participating in active or passive exercise, or not. I understand that this Release is intended to be as broad and inclusive as is permitted by the laws of the jurisdiction applicable to the facility where I am taking my training and that if any portion of this Release is held invalid, I agree that the balance of this Release should continue in full force and effect.

Signature

Date:

Printed Name

Initial Deposit

Non Refundable Deposit$500.00