Dharma House School of Yoga 200 hour Teacher Training Program - 2021 Application How long have you been practicing yoga? On adverage, how many dates per week do you practice? What is your preferred style(s) of yoga? 1st Emergency Contact (name, phone #) 2nd Emergency Contact (name, phone #) If yes, please explain If no, please explain Name one of your favorite yoga teachers Briefly, explain what brought you to the practice of yoga? Briefly, explain what inspired you to embark on a yoga teacher training program In one word, what would you consider your greatest strenght? In one word, what would you consider your greatest weakness? Briefly, explain what you hope to achieve as a result of this training? Please list your expectations of your experience at Dharma House Explain Briefly, if answered yes to "Some Challenges" Are you currently under the care of a health care professional? If yes, explain in two sentences Current medications: (answer none, if none) Is there any other condition not listed that limits your mobility or respiratory function that we need to know about? When are you available to begin the program? How did you hear about the Dharma House School of Yoga 200 teacher training program? The Dharma House School of Yoga 200 Hour Teacher Training Assumption of Risk, Health Warranty, Release and Waiver of Liability Yoga involves physical movements. The practice of yoga is an individual experience and I understand that I am responsible for progressing at my own pace, one that is in accordance with my body's abilities and limitations. I take responsibility for my own body, my movements, progress, and physical activity while participating in The Dharma House School of Yoga’s 200 hour Teacher Training Program. I understand and acknowledge that participating in The Dharma House School of Yoga’s 200 hour Teacher Training Program puts me at risk of injury. I acknowledge that these injuries may be the result of over exerting myself, not properly following the instructor's instructions, doing physical exercise beyond my abilities, misusing equipment, or improperly performing a physical activity. As such, I understand and voluntarily accept these risks. I represent that I am in good health, at least 18 years of age, have the medical approval and physical ability to engage in physical activity and yoga instructional classes and teacher training and have no disability, impairment, injury, disease or ailment which would cause risk of injury or adverse health consequences as a result of engaging in physical exercise and yoga instructional classes and teacher training. I acknowledge that the facility where I am taking my training and The Dharma House School of Yoga are relying on this representation and I understand that neither the facility where I am taking my training nor The Dharma House School of Yoga will investigate or certify my health or my fitness to participate in physical exercise and yoga instructional classes and teacher training. RELEASE AND WAIVER OF LIABILITY: In consideration for my participation in The Dharma House School of Yoga’s 200 Hour Teacher Training Program, I, individually, and on behalf of my relatives, legal representatives, and assigns, agree not to sue and hereby agree to defend, indemnify, release and hold harmless to the facility where I am taking my training and The Dharma House School of Yoga’s and each of their respective shareholders, owners, officers, directors, members, employees, contractors and agents, and the owner of the facilities (the "Facilities") where the 200 Hour Teacher Training Program occurs (collectively, the "Releases") from all actions, claims, demands, suits, losses, liabilities, charges, expenses (including, without limitation, attorneys' fees), and costs of any nature whatsoever which may arise out of, relate to, or result from, any injury, economic loss or any damage to me or my guest or relatives resulting from my participation in physical exercise and yoga instructional classes and teacher training at the Facilities, entry to or use of the equipment, facilities or services at the Facilities, the negligence of to the facility where I am taking my training or The Dharma House School of Yoga, anyone at to the facility where I am taking my training or The Dharma House School of Yoga’s behalf or anyone using the Facilities or The Dharma House School of Yoga’s equipment, facilities or services, except such as may arise out of the gross negligence or willful misconduct of the Releases. This release and waiver of liability (this "Release") is intended to be a complete release of any responsibility for personal injuries and/or property loss/damage sustained by me while at the Facilities, whether using exercise equipment, participating in active or passive exercise, or not. I understand that this Release is intended to be as broad and inclusive as is permitted by the laws of the jurisdiction applicable to the facility where I am taking my training and that if any portion of this Release is held invalid, I agree that the balance of this Release should continue in full force and effect.