Registration Form

01st January

The Yoga Pilates Training Academy Australia PO Box 308 Bangalow N.S.W Australia 2479

Phone: +61 2 66872 031
Fax: +61 2 66872 031
Website: www.yogalates.com.au
Email: info@yogalates.com.au

Name:

Address:

Phone:

Mobile/ Fax:

Email:

Date of Birth:

Passport number (OS students only):

Country:

Residential/Visa status i.e. permanent resident etc:

Your current occupation:

The practicum I wish to attend is:

2013 Practicum in Tuscany, Italy - Saturday 24th August - Saturday 7th September 2013

2013 Practicum in Byron Bay, Australia - Saturday 26th October - Friday 22nd November 2013

2014 Practicum in Byron Bay, Australia - Saturday 19th April - Friday 16th May 2014

2014 Practicum in Byron Bay, Australia - Saturday 25th October - Friday 21st November 2014

Your reasons for undertaking this course: (please compose a brief 300-500 word essay to explain your reasons for undertaking the course and insert in the below box):

List any past experience of Yoga, Pilates, Body Movement or other forms of Body Work, that you have studied and with whom:

Is there anything about your physical, emotional or psychological health that may affect your ability to do this course? (i.e. recurring injuries, asthma, depression, anxiety etc):

Where did you initially hear about the Yogalates Teacher Training?:

If unsure about attending this course please consult your medical practitioner: *

I declare that I have disclosed on this form, all relevant details and take full responsibility for myself in attending this course.

If unsure about attending this course please consult your medical practitioner: *

I have read and agree to the terms and conditions set out in the Code of Practice including Student’s Right and Responsibilities, Student Registration and the trademark and copyright of the Yogalates Method.

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