` Application Form for 200hour 100hour Yoga Therapy Certified course at Rishikesh, India

Application Form

Join 100 Hour YTTC

100 Hr. YTTC - Application Form

Note: This is a formal application form for those interested in joining the program. If you are only making an informal enquiry, then please use the contact form instead.

Personal Information :

First & Last Name * :
Email Address * :
Gender :
Date of Birth (DD/MM/YY) :
Nationality:
Language(s) Spoken :
Phone Number :
Current Occupation/ Profession :
Your Height :
Your Weight :
Choose Preferred Course Date * :
How did you hear about Ajarya
Referred to Ajarya by {?} Ajarya Family program provides a Fee Discount if you have been referred by anyone from the Ajarya family – past students / partner organizations or websites : -

Yoga Experience :

How would you put your yoga level? :
Why do you want to experience this training course?
(Check all that apply)
Physical fitness
Peace of mind / stress relief
General Inquisitiveness
Holiday/ relaxation
Seeking higher meaning to life
Other
In your own judgement, how flexible are you :
(if applicable) How long have you been practicing Yoga :
Would you like to receive future updates from Ajarya
Yes No

Health Information :

The following questions are here to help us understand you. The answers to these questions will be kept in strict confidence, and may be discussed with you to make sure that the teacher training program is the right choice for you.
Are you currently taking medication for any physical or psychological condition?
Yes No
Do you have any chronic physical limitations or disabilities?
Yes No
Do you have a history of psychological or emotional illnesses, or issues?
Yes No
Do you have a communicable disease?
Yes No
Have you had a serious illness or major surgery within the last five years?
Yes No
Are you currently pregnant or trying to become pregnant?
Yes No
If you answered YES to any of the above questions, please provide us with more relevant details as it would pertain to the teacher training program. As well, please describe if there is anything else you feel we should know with regards to your participation in the program here:
Message * :
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International Affiliations

Yoga Alliance