Blue Moon Teacher Certification Application 2018

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200 hr 8-Weekend Intensive Teacher Certification Program with Robin Neill-Kitaif, E-RYT 200 and Kim Davies, RYT200 at Blue Moon Yoga and Fitness, Ormond Beach FL, starting January 12, 2018

1Applicant Info > 2Terms & Requirements > 3Review Your Entry
Name Name Title First Middle Last Suffix
Address Address
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Evening Phone Evening Phone - ### - ### ####
Email
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Gender

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Current Occcupation
Marital Status
Yoga Practice and Experience

Please answer all questions to the best of your ability using complete sentences, with a minimum of 50 words where appropriate.
1. Describe your yoga practice:
• How long have you been practicing?
• Who have been your most influential teachers and why?
• List any trainings, intensives or retreats attended and why?
• What style(s) of yoga do you practice?
• How often and how long do you practice?

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2. Why do you want to pursue yoga teacher training at Blue Moon?
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3. Do you currently teach yoga? If so, how long and where?
4. Describe what yoga means to you? How has your life been impacted by your practice?
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6. Tell us about your hobbies and interests, your other exercise experiences, and community service involvements.
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7. Please explain the value of commitment and how it applies to your endeavor to become a certified yoga teacher.
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8. If there is anything else you would like us to know about you, and/or if you have any questions, comments or concerns, please state them here.
Physical Health

Please note that this section of the application is mandatory and that you will not be accepted without filling in these required fields accurately and honestly.
How would you evaluate your current health?

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Are you currently, or during the last two years have you been under the care of a physician or other health care professional?

Are you currently, or during the last two years have you been under the care of a physician or other health care professional? Yes No
If Yes, for what reason?
Do you have epilepsy?

Do you have epilepsy? Yes No
Do you have diabetes?

Do you have diabetes? Yes No
List your health care professional's name, specialty and address.

Practitioner Name: List your health care professional's name, specialty and address.

Practitioner Name: Title First Middle Last Suffix
Specialty
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Office Phone Office Phone - ### - ### ####
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Blue Moon Teacher Certification Application 2018

Blue Moon Teacher Certification Application 2018

Yoga Practice and Experience

Physical Health