Teacher Training Registration




Program Registration

Personal Information

(* – required)

First Name*

Last Name*

Your Email*

Company/Organization

Job Title

Address Line 1*

Address Line 2

City*

Province/State/Region*

Postal/Zip Code*

Daytime Phone Number*

Cell Phone Number*

Date of Birth* “YYYY-MM-DD”

Gender* MaleFemale

Upload a head shot (passport), file name “FirstName_LastName” (required)


Emergency Contact Information

(* – required)

Emergency Contact Name*

Emercency Contact Relationship*

Emergency Contact Phone Number*


Other Info

Please note that you must complete your application in ONE SESSION, in 120 minutes or less. If you leave the application before completing it entirely, nothing will be saved, and you’ll have to start over, from scratch.

Tuition

EARLY BIRD $2,700 CAD plus HST before August 9, 2017
$3,100 CAD plus HST after August 9, 2017

Please note that the above price includes the $500 plus HST deposit due on completion of this application. No further charges will be processed until you are accepted into the program.

Payment plans available. Please contact us.


Section 1: Yoga Practice, Teaching and Community Engagement

Have you attended any Baptiste Institute Programs?YesNo

What other yoga teacher training programs have you completed?*

List the non-yoga transformational based courses, workshops, seminars or retreats you have attended.

Whom do you consider to be your main yoga teachers and mentors, and why?*

Are you currently teaching yoga?* YesNo

Are you a Certified Baptiste Teacher?* YesNo

What studio do you practice and/or teach at?*

Where are you feeling strong in your practice? Where are you feeling challenged?*

Do you own a yoga studio? YesNo
If yes, what is the name of your studio?

Would you like your email address added to our mailing list to receive updates on Baptiste programs and community news?* YesNo


Section Two: Your Vision, Intention & Goals

What is your intention for attending this training?*

Given that anything is possible, in five years what will you have created for yourself?* (be specific)

What else would you like to share with us?

This training requires you to commit yourself 100%. This includes: being on time to all sessions, being coachable in the moment and being open to try on what is offered. Share with us what this looks like for you.


Section Three: Health & Wellness

Our intention is to create a safe environment for you and all other participants to thrive at this program. Please honor our commitment by providing honest answers to the following questions. We honor complete participant confidentiality.

What is your age?*

What is your marital status?* SingleMarriedDivorcedDomestic Partner

How would you evaluate your current health?* ExcellentGoodFair

Do you smoke?* YesNo

Do you drink alcohol?* YesNo

Do you use drugs?* YesNo

Do you have epilepsy?* YesNo

Do you have diabetes?* YesNo

Are you currently pregnant?* YesNo

Have you been hospitalized for a significant injury, condition or illness in the past year? (Please include pregnancy)* YesNo

Are you currently, or during the last year, have you been under the care of a physician or other health care professional for any significant health concerns?* YesNo

Are you currently taking or have taken in the last year any prescribed medications?* YesNo

Do you have any allergies to medications?* YesNo

Do you have a mental/emotional disorder?* (Including: depression, anxiety, bi-polar, etc.) YesNo

Are you currently, or during the last two years have you been, under the care or supervision of a mental health professional(psychiatrist, therapist, etc.)?* YesNo

Are you a trained first responder/First Aid?* YesNo

Please select your top size?* SmallMediumLargeXLarge