Online Mentoring Application

Mentoring is a mutuality that requires more than meeting the right teacher:
the teacher must meet the right student.
― Parker J. Palmer

YB Mentoring Information

Name
First Last
Date
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Please describe your past yoga teaching experience and present practice/teaching:
How long have you been practicing/teaching Yoga, and what style or teacher do you study/teach?
Strong mentors ensure that their students develop the composure, skills, and self-possession to enter the professional with confidence. This process takes a balance of guidance, encouragement and selflessness on the part of the mentor. Why do you want to study with Cora Wen? How did you find her teaching?
A mentoring relationship develops over an extended period, and is meant to help the mentee move toward their fullest potential. What are you looking to study? How do you want a mentor to help you?
Health Information
Any illness or injury that would hinder your practice. Any other physical issues or ailments to consider for you.
Emergency Contact Name
First Last
Phone
Please describe any health conditions that you could affect your yoga practice - including bone, muscle, ligament or tendon problems or injury; heart, lung, high blood pressure, back or neck pain, injury or thyroid conditions, pregnancy.
Additional Information (Optional)
By submitting this form hereby agree to the following:

1. That I am participating in the yoga classes or workshops offered by Cora Wen during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in this yoga class. I represent and warrant that I am physically ﬁt and have no medical condition that would prevent my full participation in the yoga class, health programs or workshops.

3. In consideration of being permitted to participate in the yoga class or workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

4. In further consideration of being permitted to participate in the yoga classes or workshops, I knowingly, voluntarily and expressly waive any claim I may have against Cora Wen or the owner or leaseholder of the building for injuries or damages that I may sustain as a result of participating in the program.

5. I, my heirs, or legal representative of such forever release, waive, discharge and covenant not to sue Cora Wen or the leaseholder or owner of the building for any injury or death caused by their negligence or other acts.
*
- I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
If participant is under 18: As legal guardian of this participant, I consent to the above terms and conditions.
First Last

Name of parent/guardian

Mentoring is a mutuality that requires more than meeting the right teacher: the teacher must meet the right student. ― Parker J. Palmer

YB Mentoring Information

Health Information

Mentoring is a mutuality that requires more than meeting the right teacher:
the teacher must meet the right student.
― Parker J. Palmer