I am applying for: * Summer - June 15th, 2024 Fall - September 21st, 2024 Name * First Name Last Name Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Emergency Contact Name * First Name Last Name Emergency Contact Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Phone * (###) ### #### 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 * 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 Schedule Your In-Person Interview * An in-person interview is required. Please let us know when you can visit us in person for your in-person interview. We will contact you to confirm your in-person appointment. MM DD YYYY Schedule Your In-Person Interview Time * Hour Minute Second AM PM Secondary In-Person Interview Date * Give us a second date that could also work for your in-person interview. MM DD YYYY Secondary In-Person Interview Time * Hour Minute Second AM PM 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
