Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate *

MM

DD

YYYY

Race *

American Indian or Alaska Native

Asian

Black or African American

Latin@

Native Hawaiian or Other Pacific Islander

white

Biracial

Other

Prefer not to share

How many years have you practiced yoga? *

0-1

1-2

2-3

3-5

5-10

10-15

Over 15

How many days per week to do you practice yoga? *

0

1

2

3

4

5

6

7+

How did you first learn about the YogaRoots On Location Teacher Training? *

YogaRoots On Location class

Internet search

My yoga teacher recommended it

Advertisement

Friend

Social Media

Yoga Alliance

Other

How would you evaluate your current health? *

Excellent

Good

Fair

Some challenges

Are you experiencing any of the conditions below? *

Epilepsy

Diabetes

Hypertension

Heart conditions

No, I am not experiencing any of the above conditions to my knowledge

Pregnancy Status

Currently pregnant

Recently pregnant

Plan to become pregnant soon

Prefer not to disclose

None of the above

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Which pay tier best aligns with your resources? *

$3,500 Individual Tier - I can afford this program at cost.

$5,000 Community Tier - I have more than enough resources and would like to supplement others’ participation.

$6,000 Collective Tier - I have more than enough resources and would like to supplement others’ participation.

$7,000 Sustainable Tier - I have abundant resources and would like to supplement others’ participation.

None of these tiers is accessible to me and I would like to hear about scholarship opportunities.

The most accessible tuition payment schedule for you is:

In a single payment

In monthly installments set at an amount of my choosing

None, I will require full scholarship to join the training

Terms and Requirements *

I understand that if I fulfill all the requirements of the YogaRoots On Location Teacher Training, including in-class hours, homework, quizzes and final exam, I will receive a certificate of completion, which can be submitted to the Yoga Alliance or a prospective employer as evidence that I have completed a 200-hour Teacher Training program. I understand that at the end of my training I will be responsible for the registration fees and dues charged by Yoga Alliance for my 200-hour RYT certification. The current registration cost is $115. I understand that this yoga teacher training includes 25% racial and social justice work, 25% physical yoga practice, and 50% Raja Yoga practice. I understand that YogaRoots On Location reserves the right to ask me to leave the program if my behavior is inappropriate, unethical or violates the Yoga Alliance Code of Conduct (https://yogaalliance.org/AboutYA/OurPolicies/CodeofConduct). Under such circumstances I understand I will not be refunded my tuition. I understand if I cancel within 14 days of the start of the training, I will forfeit my deposit but my remaining balance will be refunded. Once the program begins, tuition is nonrefundable and non-transferable. If for any reason the training is canceled by YogaRoots On Location, LLC, you will receive a full refund of your security deposit plus any additional monies received. I understand that all YogaRoots On Location Teacher Training materials are under copyright protection and cannot be reproduced or redistributed by me without the permission of the author. I have read and accept the above terms and requirements.

Yes