Karma Yoga with Garden Focus

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1 Welcome

3 Participant Information

All the information entered here will be kept private. Please fill out as much as you can. Required fields have a red *

Spiritual Name
Gender *	Male Female
Birth Date *
Birth Time
Birth Location
Marital Status
Languages Spoken

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4 Arrival / Room Info.

Dates *	When would you like to come and for how long?

5 Contact Information

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Emergency Contact Info - Name *
Emergency Contact - Address *
Emergency contact - Phone Number *
Emergency Contact - Secondary Number *
Emergency Contact - Email *
Emergency Contact - Relationship *

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How did you hear about us? *
If Other, then please tell us how you heard about us *
Have you previously visited the Yoga Farm? *	If yes, please let us know when was the last time
Sivananda TTC Graduate? *	yes no
Yoga Experience *	Please describe your experience with yoga and meditation
Your Practice *	How regular is your yoga and meditation practice?
Occupation *	Please describe your work history
Gardening Experience *	Please describe your history of gardening experience. Include any certifications if applicable.
Education *	Please describe any formal or informal education experience.
Skills *	Any additional skills that you think would be useful such as cooking, carpentry, gardening, landscaping, etc?
Work independently? *	yes no Are you able to work independently and willing to do the duties assigned to you?
Willing to Learn? *	Yes No Are you ready to learn new skills and help in areas you are not familiar with?
Take directions? *	Yes No Are you able to take directions?
Open to new ideas? *	Yes No Are you willing to open yourself to new ideas and teachings?
Medical Issues *	Enter "none" if you have no issues
Prescribed Medications	enter "none" if you are not taking Drugs, alcohol, and cannabis abstention for one month prior to application required.
Substance abuse: *	Please describe your history of drug or alcohol use:
Criminal Record *	If you have a criminal record, please provide details
Mental illness: *	If you have ever suffered from any mental illness or been in a mental institution, please explain:
Understanding of Karma Yoga *	Please write a brief explanation of your understanding of karma yoga and your reasons for wanting to come to the ashram, including what you hope to achieve during your stay:
Comments or Special Needs
Special Diet

1 Welcome

2 Additional Programs

Participants

3 Participant Information

4 Arrival / Room Info.

5 Contact Information

6 Additional Information

7 References

8 Agreements

Reference 1 *
Reference 2 *
Reference 3 *