Mandorla Yoga Institute
Student Enrollment Form
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Conditions
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Heart Condition
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Past Heart Surgery
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Concussion
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Yoga Goals
Increase Well-being
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Injury Rehabilitation
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Positive Reinforcement
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Address Health Issues
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Strength Training
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Alternative Therapy
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Stress Relief
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Balance
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Flexibility
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Improve Fitness
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Other
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Yoga Interests
Meditation
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Pranayama (breath work)
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Yoga Philosphy
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Asana (postures)
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Eastern Energy System
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Other
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Yoga
Have Practiced Yoga
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Date of Last Yoga Class
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How Often?
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List Expectations
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Anusara
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Ashtanga
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Gentle
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Hatha
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Iyengar
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Kundalini
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Power
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Restorative
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Vinyasa/Flow
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Yin
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Number of Times of Week You Practice
Once a week
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2-4 times a week
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More than 4 times a week
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Less than a couple of times a month
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Allergy
Sensitive to scents/essential oils
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