Hatha Vidya Gurukulam

Natha Tradition of yoga

THAPOBHOOMI NEERNNAMUKKU, CANAL ROAD,VADAKKETHARA,
PAZHAYANNUR, THRISSUR 680 587, KERALA, INDIA.

APPLICATION FORM

Your Personal Details

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Your Program Details

Please select when and where would you like to attend the course.

Yoga Related Details

Please provide details of your yoga experience and what do you expect from the course.

Medical Declaration

Please provide the health condition and medical history
  High/low blood pressure
 Diabetes
 Spine related conditions
 Drug abuse
 Heart conditions
 Bowels
 Heart murmur
 Peptic ulcer
 Arthritis
 Epilepsy
 Thyroid Ailments
 Mental Illness
 Heart attack
 Tuberculosis
 Bronchitis
 Liver disease
 Asthma
 Stroke
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No
Yes
No
Yes
No
Yes
No
Yes
No
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No
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I declare that, I have filled out the form to the best of my knowledge, and the answers to all the questions are correct. I fully understand that any misinterpretation to this declaration could lead to the termination of my training without any refund.

Over the Yoga Practices during this training, if any injury occurs to my body, as a result of my mistake, I’ll be considered totally accountable for this and all kinds of expenses for its recovery will probably be taken care by me.

I understand that during the event Hatiha Vidya Gurukulam will be taking photos and post them on Facebook and other social media channels. If I do not like any of the photo I can always request to remove it.

 I agree*

Review Your Entry

Please review your entry below. Click Submit button to finish.
Name

Name as required on the Certificate

Date of Birth

Email

Gender

Address

Phone Number

Whatsapp Number if you would like to be part of this group during the training

Emergency Contact Person

Relation with the above person

Phone Number of above person

T-Shirt Size

Food Allergies or Special Request

Please select the location

Please select the Program

What style of Yoga, have you been Practicing or Teaching so far?

From where and when did you learn it?

What do you expect to gain from the yoga teacher training course?

Do you have any physical disabilities or use any mechanical/physical assistance for mobility. If yes, please provide details.

Have you had any form of serious illness or operation in the last few years? Please provide details on the date and the details of the illness/surgery.

Have you been treated or hospitalized for cancer, tumor, cyst or any other growth? If yes, please provide details.

Are you using any medications? Please provide details.

Any pre or post complications after giving birth?

Have you ever suffered or are you suffering from any of the following? Please provide details if yes.

Is there anything else you would like us to know?

I understand that illegal drugs will NOT be permitted for the duration of the training. Students who cannot comply with this rule will be asked to leave.

I understand that this teacher training course will be both physically and mentally challenging, with two, 90-minute yoga practice daily along with 5-6 hours of required class and workshop time.

I take full responsibility for my own health and well-being during the course and will not hold Siddhi Yoga or any of the teaching staff responsible for injuries or other medical problems that might occur.

I understand that the course deposit of 500/600/1000 USD is non-refundable and that remaining tuition paid is 100% refundable up until 60 days before course start date, after which time, it becomes non-refundable as well.

I understand that Siddhi Yoga follows the curriculum guidelines of the Yoga Alliance; and therefore, requires all participants to show up, participate, and commit 100% to the course. Students who give 100% will almost certainly graduate successfully. Those who do not may jeopardize their certification.

I understand that a positive, team-oriented, optimistic attitude is a requirement for all attendees. Disruptive, rude, or negative behavior will not be tolerated and may result in removal from the course.

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
I declare that, I have filled out the form to the best of my knowledge, and the answers to all the questions are correct. I fully understand that any misinterpretation to this declaration could lead to the termination of my training without any refund. Over the Yoga Practices during this training, if any injury occurs to my body, as a result of my mistake, I’ll be considered totally accountable for this and all kinds of expenses for its recovery will probably be taken care by me. I understand that during the event Hatha vidya will be taking photos and post them on Facebook and other social media channels. If I do not like any of the photo I can always request to remove it.

How you came to know about us?