Yoga and the 12 Steps (Online) Application

Name*

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Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

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Phone Number: (If you would like to get the conversation going with one of our instructors, please indicate your cell or WhatsApp number.)*

Please share a little about yourself so we can get to know you (work, family, hobbies, etc.)*

What do you hope to gain from taking this course?*

What drew you to this course?*

Are you familiar with the 12 Steps? If so, please share a little about your experience/knowledge of the 12 Steps (what feels comfortable for you to share). You may say something as general as “Yes, I am familiar with the 12 Steps” or as specific as “I am in 12 Step Recovery”.*

Do you practice meditation? If so, you may share about your practice if that feels right to you?*

Do you practice yoga postures? If so, please share a little about your practice (e.g. what type of Yoga and how often).*

If you are a certified Yoga Teacher, and wish to take this course for continuing education credit, please tell us your name as it reads on the Yoga Alliance teacher directory.*

Ananda takes a classical approach to Yoga: as an aid in the quest for Self-realization, for union of soul with Spirit. Course participants are not expected to follow Ananda’s spiritual path; however, the Yoga component of the course will reflect Ananda’s teachings of Self-realization. The course will encourage you to grow on your own spiritual path and apply the teachings in ways that are relevant to you. Does this seem like a good fit for you?*

Yes
Not sure

Medical Questionnaire: It is important for the instructor to be familiar with the students’ health because Hatha Yoga practice is part of the course.

Medical Questionnaire: What is your birth year?*

Please briefly describe your current overall health.*

Describe your history (include dates) of back/spine/neck problems, and indicate if you are currently having any issues. Please be specific.**

Describe your history (include dates) of joint problems (knee, hip, shoulder, etc.), including joint repair/replacement surgeries. Please be specific.*

When was the last time your blood pressure was checked and was it normal, high, or low?*

Are you pregnant? If yes, when is your due date?*

Are you currently seeing, or have you seen in the last 5 years, a physician or therapist for any physical or mental/psychological conditions? If yes, for what conditions?*

Are you currently taking medication for any physical or mental/psychological conditions? If yes, what medications, for which conditions, and how frequently?*

Please check any of the following difficulties you have had and explain relevant specifics in the next question.*

Please explain the above health conditions you checked off in greater detail and with relevant dates.*

I hereby certify that the above information is correct to the best of my knowledge, and I will continue taking all medications as prescribed by my health care practitioners(s) while taking the Yoga and the 12 Steps course.*

Please share any other personal information that you feel we should be aware of, or concerns that you may have about this course.

How did you first find out about this course?*

During your participation in the program, we will be taking photos and videos or screenshots of class recordings for marketing purposes. Do we have permission to use any photos and videos of you?*

Yes
No

Have you taken any courses/classes with Ananda online or in person, or visited The Expanding Light Retreat and/or been involved with an Ananda center? If yes, please explain.*

Have you taken a Yoga and the 12 steps course with Vivekadevi before? Please specify the approximate dates and whether is was in person or online.*

I have read and understood the Frequently Asked Questions section (including requirements for obtaining CE credits).*

Yes
No

Terms & Conditions for Yoga and the 12 Steps Online

Participants must agree to the following terms & conditions for this course:

a) You will not share the course manual or other course materials with anyone.

b) Those seeking continuing education credit with Yoga Alliance must attend (or watch) all weekly webinars, participate in the weekly online class discussions, and complete any quizzes - if offered for a module.

c) Refund Policy: If you cancel 14 days or more before the start of the program, your payment will be refunded, less a $150 processing fee. If you cancel within 14 days of the start of the program, then 50% of your payment will be refunded, and the remainder will be forfeited. If you cancel more than 14 days after the start of the program, the full program cost will be forfeited.

Accept Terms and Conditions*

Yes, I accept Terms and Conditions

Ananda Course in Meditation