Registration Form - Dharma House IIYS

Individuals seeking enrollment into the Dharma House IIYS program must submit an registration and pay an $200 registration fee (in the next screen). Payment of registration fee demonstrations acceptance of all Dharma House IIYS policies.
Dharma House IIYS offers a rolling enrollment. This means that registrations and students are accepted year-round. Students choose what month they would like to start.
Please contact the school Director, Christy Harris, (Dharana Shakti) if you have any questions about the timing of your enrollment or plans for completion. All coursework complies with the Dharma House IIYS Code of Ethics and Scope of Practice established by Yoga Alliance (YA) and the International Association of Yoga Therapist (IAYT).

Which program are you registering for?*

Full Name*

Address*

E-mail*

Phone Number*

Birthday*

Birthday

Text Field

Emergency Contact #1 (name and phone number)*

Emergency Contact #2 (name and phone number)

How long have you been practicing yoga?*

What is your prefered style of Yoga?*

Have you ever attended a yoga workshop or retreat

Yes
No

Which program are you apply for?

200 hr RYT
300/500 hr RYT
IAYT Yoga Therapy

Do you have a meditation practice*

Briefly, explain what brought you to the practice of yoga?*

Please briefly list your expectations of your experience at Dharma House IIYS.*

In one word, what would you consider your greatest strength?*

In one word, what would you consider your greatest weakness?*

MEDICAL HISTORY is necessary to have on file should an emergency occur during the teacher training program. Please provide you health history: How would you rate your current overall health?

Excellent
Good
Fair
Some Challenges

Explain Briefly, if answered yes to "Some Challenges

Are you currently pregnant?

Yes
No

Are you planning to become pregnant during the course of teacher training?

Yes
No

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?*

How did you hear about the Dharma House IIYS school?*

The Dharma House Institute of Interdisciplinary Yoga Studies 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 Institute of Interdisciplinary Yoga Studies Training Programs 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 Institute of Interdisciplinary Yoga Studies 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. By typing your name here you understand the above statement*

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. By typing your name here you understand the Release and Waiver of Liability*

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