What best describes your reason for pursuing teacher training?
Please choose one.
I wish to only deepen my personal practice I do not plan to teach yoga.
I wish to not only deepen my personal practice, but I also plan to teach yoga.
If you do NOT have a consistent practice, how do you feel this training will help you?
Please use this space for any other condition not listed above that you believe might limit your ability to participate in class or comment on any of the above conditions.
Please read each statement carefully and check the boxes to indicate your agreement and understanding:
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction, and muscular tension relief. As in the case of most physical activity, the risk of injury (including serious and/or disabling injury and possibly death) is always present and cannot be entirely eliminated. While at the studio, I agree to honor and respect my body's capacity for movement as well as those I practice with.
Awareness is fundamental to the practice of yoga. It is fully my responsibility as a student to monitor each activity and determine whether it is appropriate for me to participate. If any pain or discomfort is experienced, I will listen to my body, make appropriate adjustments, and ask for assistance if necessary. By choosing to participate, I voluntarily assume responsibility for any injury.
I understand that is it my responsibility to consult a physician prior to and regarding my participation in a yoga class. I recognize that is it my responsibility to notify the teacher of any recent illness, injury, or surgery before every yoga class. I understand that certain yoga poses and/or breathing exercises are contraindicated for particular medical conditions (e.g., cardiac illness, post-surgery, later stages of pregnancy), and that yoga is not a substitute for medical attention, examination, diagnosis, or treatment.
I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now, or hereafter may have, against Sync Mind/Body/Fitness, LLC - DBA: just breathe mindful movement studio, their teachers, and/or its studio space leased from Zamias Property Management. I agree that just breathe mindful movement studio, its teachers, and/or its studio space shall not be liable for any claim, demand, or cause of action of any kind whatsoever for, or on account of personal injury, property damage, or property loss of any kind resulting from or related to my use of the facilities or participation in any group activity or personal session.
I affirm that I have read and understand the above statements and voluntarily agree to the terms and conditions stated above.
If you do not currently practice yoga, please skip this section.
How long have you been practicing yoga?
If you are not currently practicing yoga, please move on to the next question.
Less than 1 year
How often do you practice yoga?
How has your yoga practice personally affected your life?
What type(s) of yoga have you practiced? Please indicate how long you have practiced each type.
(Hatha, Vinyasa, Yin, Ashtanga, Iyengar, Kundalini, etc.)
Give a brief statement describing your most influential teachers and their qualities.
What are the goals and/or skills you hope to gain by taking this training?
Do you have experience with other movement and/or meditation forms? If so, what specifically?
What is your educational and professional background outside of yoga?
How would you rate your overall physical and mental health?
Please include information about any relevant current or past medical conditions or significant life events or situation/changes.
QUESTIONS FOR THOSE WISHING TO TEACH YOGA
If you are not interested in teaching yoga, please move on to the next section.
Why have you chosen to become a yoga teacher at this stage in your life?
Describe the population and style of yoga you envision gaining the skills to teach.
PROGRAM & LIABILITY AGREEMENT:
Please read the following and check each box to agree.
I take full responsibility for my experience in the Personal Immersion/200 Hour Yoga Teacher Training (PI/YTT) through just breathe mindful academy. I understand the just breathe mindful academy Personal Immersion/200 Hour Yoga Teacher Training may be challenging for me physically, emotionally and spiritually. I agree to take care of myself at every level. I agree to contribute to a learning environment that is safe, respectful, and constructive for myself, and everyone involved in the training.
I acknowledge the practice of yoga often involves exploring my personal edges and limits. Just breathe mindful academy PI/YTT is not responsible for any physical or psychological challenges I choose to explore throughout my educational journey. Just breathe mindful academy PI/YTT will not be held fiscally responsible for, or reimburse me, for any physical or psychological treatment during or after this program.
I acknowledge just breathe academy PI/YTT staff cannot be responsible for attending to, or managing, every student’s individual needs. This training program intends to meet the needs of the majority and therefore, at times, may not apply or align with my personal limitations or beliefs.
I am aware it is my responsibility to alter, adjust or discontinue any experience that does not feel safe or appropriate to me. If I feel unsafe, I will communicate my discomfort with clarity and respect to others and ask for assistance. I will not assume the PI/YTT Training Staff is aware of my individual experience and will automatically know to take care of my personal needs.
ALL STUDENTS OF THE PI/YTT
Please read the following and check each box to agree.
ACCEPTANCE OF RISK: I will not hold just breathe academy PI/YTT liable for ANY psychological or physical injury occurring before, during or after this training program. I am of sound mind and body, capable of participating safely in this training program. I fully recognize and accept any risk that I undertake in this program. If I have any concerns, I will consult with my health care providers for approval.
PI/YTT PROMOTIONAL EFFORTS: During this training PI/YTT staff may take photographs and make audio/video recordings of the training to promote the benefits of participating in its programs and activities. During any photography or recording, I can tell a PI/YTT staff that I do not wish to participate. I can move to a place in the room that is not being photographed or recorded. I hereby consent to otherwise be the subject of any photographs or audio/video recordings made during my training. I grant permission for these to be published or posted in ways that promote the PI/YTT.
SOCIAL MEDIA/POSTING OF PHOTOGRAPHS & VIDEOS: Any use of the just breathe academy PI/YTT name or logo requires our expressed permission. I understand I am solely responsible and potentially liable for any images posted creating harm or damage to anyone or the studio as a result of my online activity related to the PI/YTT.
ABUSE OF ONLINE YOGAANATOMY.NET USAGE: just breathe academy has purchased the rights to use the yogaanatomy.net Fundamentals course for educational purposes of the students in our PI/YTT or other studio continuing education sessions. Students found sharing their access or abusing their individual privileges gained through this training, will be subject to dismissal of the training program without refund.
After being informed of the above risks and responsibilities, I generally release, Synchronicity Mind/Body Movement, LLC DBA: just breathe mindful academy & just breathe mindful movement studio, Pinnacle Chiropractic and L & E Enterprises, LLC and any instructors and other representatives, from all claims, causes of action, medical expenses, and other costs related to my participation, whether they arise during my training or from my later use of information or instruction at home.
RELEASE OF LIABILITY: By checking this box and digitally signing this agreement, I will abide by the terms set forth for this PI/YTT 200 Hour Certification Program and Liability Agreement and accept just breathe mindful academy’s policies and enter a legally binding general release of liability.
Please type your full name here to serve as your digital signature and understanding of the above statements.
Please select how you will be submitting your non-refundable $50 application fee:
I will stop in to the studio with cash or check.
I will mail a check to Lynne McQuillan, 79 Dahlia Street, Johnstown PA 15905
Please remember to stop in or mail your $50 non-refundable application fee made payable to just breathe. Checks may be mailed to: Lynne McQuillan, 79 Dahlia Street, Johnstown PA 15905