Date of Birth *

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DD

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please tick the boxes that apply to you.

Do you have any pre-existing medical conditions or injuries?

Are you suffering from or have recovered from a psychological illness?

Are you currently pregnant or trying to become pregnant?

Are you a current or past user of recreational drugs, tobacco or alcohol?

Do you have any problems maintaining a vegan diet and undergoing an Intermittent fast, only eating within a window of 8 hours per day for the 9-day Retreat?

Are you currently taking any form of medication or undergoing treatment?

Name of Emergency Contact *

First Name

Last Name

Code of Conduct *

1. Your attendance will be recorded for this course in strict adherence to Yoga Alliance Standards. If you do not achieve the requisite hours of course attendance your certification will be withheld and you will not be able to graduate. Therefore, please arrive punctually for all sessions and stay till their completion. Absenteeism includes failing to show up within 15 minutes of the start of each session. 2. Please refrain from engaging in disruptive behaviour during sessions, including but not limited to: conversations with other course mates, responding and texting with your cellphones or engaging in phone conversations during practice, lectures or meditation sessions. 3. Food is prohibited within the yoga space unless expressly allowed by the teacher. 4. The use of alcohol and other intoxicants is strictly prohibited. 5. Teacher Training can be an intense and challenging experience for all involved. Please adopt a positive attitude, and provide a supportive environment for others. You agree to conduct yourself in a respectful manner towards all teachers, fellow classmates, and staff. 6. The Course leader reserves the right to refuse entry and mark attendance for any student not abiding by this Code of Conduct.

I agree to abide by the Code of Conduct.

Liability Waiver Agreement *

1. I recognize that yoga involves physical exertion, which may be strenuous and may cause physical injury. I understand that I must judge my own capabilities with respect to practising yoga. By my participation in yoga classes/private sessions, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur in such practice. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga. I acknowledge that it is my responsibility to inform my teacher of any injury or other condition that might affect my ability to participate and to inform her immediately if an injury occurs during a session. 3. I understand that my teacher may physically adjust me for proper alignment or to help me experience a pose better. If I feel uncomfortable, it is my responsibility to let my teacher know that I do not want to be touched. 4. I understand that my enrolment fee does not entitle me to a Certificate of Completion. This will be dependant on the Course Leader's Evaluation of my physical and academic performance as well as acceptable behaviour during the course. 5. I hereby understand that the Nithya Priyan School of Yoga from time to time may photograph or video record classes or events, and may publish such photographs and videos on its website and on the social media platforms such as Facebook, Instagram, Google+, and Youtube. I hereby consent to the use of my image that may appear in any such photograph or video. 6. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Nithya Priyan Pte Ltd and its teachers. 7. I have carefully read this waiver and release, fully understand, and voluntarily agree to the above.

I agree to the terms of the Liability Waiver Agreement