Chicago School of Yoga Teacher Training Application I am applying for: * Winter Trimester - January 20th, 2024 Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Date of Birth * MM DD YYYY Phone * (###) ### #### Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Emergency Contact Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Education Background * Schools Attended & Dates * Occupation & Employer * Hobbies/Activities * Injuries/Physical Concerns * Do you have any allergies? Please list below: * How did you learn about us? * What is your background in yoga? Tell us about your yoga practice and training. * What first brought you to yoga and how long ago? Do you have any significant experiences you would like to share about your personal or professional practice? * What teachers have had the most influence on you and why? * Have you ever taken any yoga teacher training before? Please provide any pertinent details... * What are your goals for taking this course? What do you hope to take away from this experience? * Please add anything else about yourself that you feel is pertinent, such as injuries, limitations, weaknesses, strengths, special skills, areas of interest, etc... * COVID-19 Vaccination Information COVID-19 Vaccination * All students are required to show proof of COVID-19 vaccination, as we are a vaccinated facility COVID-19 Vaccination * What was the date of your first Covid-19 Vaccine Shot? MM DD YYYY COVID-19 Vaccination - 2nd Dose * What was the date of your second Covid-19 Vaccine dose? If you only received one dose, please fill out with the same date as first shot. MM DD YYYY COVID-19 Vaccination - Third/Booster Dose * * What was the date of your third Covid-19 Vaccine dose? If you only received one dose, please fill out with the same date as first shot. MM DD YYYY We have received your application for the upcoming trimester. To secure a spot please contact Mark Weiss the Executive Director of The Chicago School of Yoga via phone or email at: 1-312-617-3630 or mark.csoy@gmail.com Pay with Venmo @sendpmt or with Cash or Check
