ApplicationPrint PDF Application Personal InformationSurname (required) First Name (required) Date of Birth (required) Age (required) Sex (required) MaleFemaleMarital Status (required) SingleMarriedCity, State, Country of Birth (required) Nationality (required) Passport Number (required) Knowledge of English (required) FluentAveragePoorDates Interested in Yoga Retreat (required)October 9, 2016–October 29, 2016December 1, 2016–December 20, 2016March 5, 2017-March 24, 2017May 3, 2017- May 22, 2017July 1, 2017- July 20, 2017September 28, 2017- October 17, 2017November 26, 2017- December 15, 2017AddressPermanent Address (required) Telephone (required) Email (required) Yoga ExperienceDescribe your yoga background (required) Yoga TrainingInstitution Course Duration Yoga TeachingDuration Location Country Ashram Life or Yoga/Meditation RetreatDuration Location Spiritual TraditionTradition Guru's Name Spiritual Name Initiation Date AlimentationAt the retreat simple vegetarian food is served.Please list any food items that you cannot eat Food Allergies or Intolerances Personal NoteMother or Father's Name and Address In case of emergency please notify the following person. Include name, phone no., email and relationship Medical HistoryDo you suffer from any illness or any symptoms? If yes, provide details. Do you have or have you ever had any mental disorder? If yes, provide details. Do you have any addictions? If yes, provide details. Do you currently need any medications? If yes, provide details. Would you like to gain or lose weight? If yes, why? Do you have any children? Pets? What is your occupation? How many hours a week do you work? Please list your main health concerns: Do you have other concerns and/or goals? At what point in your life did you feel your best? Do you sleep well? About how many hours a night? Do you have allergies and/or sensitivities? Please explain. Are you involved with any healing therapies? Please explain. Will your family and/or friends be supportive of your desire to make food/or life style changes? Please explain. Do you crave sugar, coffee, cigarettes, or have any major addictions? How is your mood generally? Please explain. Do you consider yourself a compassionate person? Do you tend to help ones in need or are you indifferent to them? What are your motivations? How do you see yourself in five years? Do you consider yourself a mature person? Do you judge people easily? Do you consider yourself to be a happy person? Why or why not? How are you in a group setting? Do you contribute to a better group dynamic? How was your childhood and youth? How is your relationship with your parents? What would you like to change about your life regarding your relationships, character, etc? Anything else you want to share? I have made a deposit for the YTT through Paypal or Western Union as stipulated on the YTT Course Information page. (required)DeclarationI (Name) , hereby declare that the information given in this application is true and accurate to the best of my knowledge. Sembrando Semillas con Yoga has the right to change and/or reverse any decision made on the basis of incorrect or incomplete information.I further understand that I need to have my own insurance as Sembrando Semillas con Yoga will not be responsible for any accidents which may occur during the time of your stay. Furthermore, I understand that the reservation payment is not refundable less than 30 days before the course, I agree that eventual refunding of the reservation payment is only done by 50 % of the total amount.Disclaimer:I take full responsibility for my behavior, my inner experience, my health, my mental condition and my interaction with others during the course, and, according to the usual procedure, I release the organization Sembrando Semillas con Yoga, the responsible teachers, and other included parties from any liability claim.Date (required) Signature (required) [anr_nocaptcha g-recaptcha-response]