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Application for January 2-25, 2015 N.Z. Teacher Training
with Donna Farhi & Faculty
This application is to assist both you and the staff in determining whether this training is suitable for you.
All information you provide should be offered candidly and you may trust that it will be held confidential. We
hope it will assist us in serving you during the training. Please do not make your travel arrangements until
you have been accepted into the training via email.
Application Check List
Please staple a recent headshot of yourself to the upper left- hand corner of this page or insert a photo
as a picture into this word doc. if you are returning this application by snail mail.
If you are scanning and returning this application by e-mail, you can simply send your photo in a
separate e-mail.
If you have not previously studied with Donna Farhi you will need to provide two references, preferably
from at least one teacher or colleague with whom you have studied.
Please attach your letters that are signed and dated by the referee to this application or if returning by
e-mail, please scan and attach.
My application has been signed and dated.
Please be clear and concise with your responses, including no more than three paragraphs to answer a
question.
1. How did you find out about this training?
2. Could you please describe your Yoga experience, noting teachers and methods that have been
influential to you?
3. How many years have you been practicing Yoga?
4. Please describe the content and average length of your daily personal practice. E.g. asana practice,
meditation or prayer, breathing & pranayama, other somatic practices such as Feldenkrais, dance or
Alexander work, as well as service or devotional practices.
5. How many years (if any) have you been teaching Yoga? Do you specialize in teaching a particular
audience? (E.g. beginners, seniors, prenatal, athletes, therapeutics, special needs, meditation, stress
management.)
6. Have you attended workshops with Donna before? If so where and when?
7. What is your educational background? Please list schools attended, dates, and any degrees or
certificates received. You may enclose a C.V. instead of answering this question.
8. What do you consider to be your main strengths and weaknesses as a yoga practitioner and/or teacher?
9. List your three main objectives for taking this training.
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10. While it is not necessary to be able to do advanced Yoga postures it is essential that you are in good
health and physical fitness to participate fully in this training. Do you have any physical issues or health
conditions that could affect your participation in the training?
11. Are you currently taking any medications? Please note which ones and the purpose of the medication.
It is particularly important to note any psychiatric medications you may be taking for depression or mental
illness. (Several individuals in previous trainings have incorrectly assumed that including information
about mental illness in their application would result in their not being accepted. This is not the case. We
may, however, need further information to determine whether the program will be suitable for you, and
we may request that you get a written clearance from your health practitioner or therapist to be away
from your normal support network. The inclusion of this information is also intended to help the teaching
faculty give you additional supervision and support, should you need it. The support we can offer,
however, is only within the scope of a professional Yoga teacher and is not intended to replace
professional psychotherapy, counseling or medical treatment offered by an appropriate qualified health
practitioner or doctor.)
12. I acknowledge the inherent risks associated with Yoga and any physical exercise. I accept those risks
and enter into the above mentioned teacher training freely of my own decision so that I will hold no-one
(including Donna Farhi, Lisa Petersen, Neal Ghoshal, Karla Brodie, junior assistant teachers, Ladino 2004
Ltd, or the Rangi Ruru School staff) to blame for any injury, whether physical or mental, arising out of the
attendance of the workshop, associated exercises and following of any printed literature and use of the
premises. A more detailed waiver will be sent to you one month prior to the teacher training so that you
have time to read it carefully. This document is to be signed during registration on the first day of the
teacher training.
I have answered these questions honestly and submit them as my application to this training.
Name______________________________________
Date_________________
Signature_________________________________________________________
* It is important that this document and your registration form include your signature, so please don’t
return by e-mail without a signature on these documents. A typed name will not suffice.
Other Information We Need from You:
Dietary Requirements
It is vital that we have your dietary information so that our caterers can do their best in meeting your
needs. The basic diet is lacto-vegetarian (includes eggs and milk) with some fish options. We try however
to minimize the use of dairy foods and we incorporate many non-gluten and non-dairy options into each
meal. As many of the selections are offered buffet style you can self-select and thereby often avoid foods
that do not agree with you. There will be some refrigerator space for personal supplements, but if you
need specific foods you can purchase your own supplies at nearby supermarkets.
I will eat fish when it is served.
I have a medically confirmed allergy or intolerance. Please specify…
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REGISTRATION
Name
Address
City
State/Zip
Country
I enclose with my application:
$1,500.00 deposit
Total Amount (an option for those wanting to
take advantage of a favorable exchange rate)
Single $6,685.00
Double $5,995.00
I would like the following payment plan:
Single: $2,593.00 on April 10, 2014 and
$2,592 on August 10, 2014
Phone
Double: $2,248.00 on April 10, 2014 and
$2,247 on August 10, 2014
E-mail
I will pay the balance the following way:
I am paying by cheque made out to LADINO
2004 LTD. I have included two cheques
postdated for the balance payments due April
10, 2014 and August 10, 2014.
Age
Name, relationship and contact number of closest
relative or friend in case of emergency
I am paying by electronic funds transfer
Contact Melissa Gardiner for details
Fees:
$3,465.00 N.Z. Tuition for training
includes training manual
$6,685.00 N.Z. Single total cost
Tuition, single bedroom & 3 meals per day
$5,995.00 N.Z. Double total cost
Tuition, double bedroom & 3 meals per day
Payment:
• Deposit of $1,500.00 N.Z. due when you
submit your application.
• 1st Payment is due April 10, 2014
$2,593 Single or $2,248 Double
• Final Payment is due August 10, 2014
$2,592 Single or $2,247 Double
Payment must be in N.Z. currency
and cheques made out to Ladino 2004 Ltd. There
is also the option to pay by electronic funds
transfer. Please be diligent with payments, as
any payments not received within 2 weeks of a
due date will result in that person losing their
space in the training. Make a note of when the
balance payments are due and ensure that
adequate funds are available on your card or
cheque. If your card expires, it is your
responsibility to inform Melissa Gardiner, Donna’s
Office Manager, with the new date two weeks
prior to balance payments. If you are paying by
cheque we ask that two post-dated cheques are
included to cover the balance payments.
* There will be a $30 N.Z. charge for all transactions
that have to be resubmitted either due to lack of funds
or old expiration dates on credit cards or cheques.
I am paying by Visa or MasterCard
Registration
CC#
exp date
cvs code
Name on card
I authorize you to debit my Visa/MasterCard
for the amounts that are checked above.
Signature
Cancellation Policy:
Your space is reserved after a deposit is paid
however registration is not final until full
payment is received and your application is
accepted. If you cancel before April 10, 2014
your deposit will be refunded less a $150.00
administrative fee. If you cancel before August
10, 2014 your monies will be refunded less a
$200.00 administration fee. If you cancel after
August 10, 2014 your monies can only be
refunded if your place can be filled by the wait
list.
I have read and accept the general
business terms described on this
registration form.
Signature
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Yoga Props and Roommate Request
Although we have a large stock of blankets and bolsters for our events, with the numbers for this training
we need to request that every participant bring the items listed below. We realize many of you are
traveling to attend the training and suggest that you put your yoga props in an inexpensive large duffel
bag. Please make sure that your props are clearly marked before you arrive.
New Zealand participants:
If you are driving to the event you will need to bring:
3 cotton or wool blankets, 2 bolsters, 1 belt (preferably a thick cotton webbing belt with metal D-ring at
least 8 feet in length), 1 yoga mat, 1 yoga block
If you have additional bolsters or blankets that you can bring, we would greatly appreciate it!
Yes, I can help by bringing ____ blankets and ____ bolsters.
Participants flying within New Zealand to the event you will need to bring:
2 cotton or wool blankets, 1 bolster, 1 yoga mat, 1 yoga block
International Participants you will need to bring:
1 bolster and 1 yoga mat. Please let us know which of the following options you choose:
I would like to purchase a bolster upon arrival for approximately $80.00 NZ (You may wish to research
the cost of baggage excess charges when making your decision. These can often be considerably higher
than purchasing a bolster on arrival.)
I would like to purchase a bolster upon arrival and sell it to Ladino 2004 Ltd for half price at the end or
the training.
I will be bringing my own bolster/bolsters.
Roommates
I have signed up for a double and would like to room with:
I have signed up for a double and would like you to find me a roommate. I do not snore.
If you snore, you must use a single room or come with your own roommate who is OK rooming with
you. As you can imagine, this issue has caused quite some trouble in previous trainings.
* Please note that if we match you with a roommate and you do snore, you will be required to move to a
single and pay the difference. (i.e. The cost of your upgrade to a single as well as the cost of upgrading
your roommate to a single)
I have read the above and agree to these terms:
Signature:
For more information or to register:
Contact: Melissa Gardiner
Postal address:
Teacher Training, 140 Ashworth Bush Rd, RD7 Rangiora 7477, North Canterbury, New Zealand
Phone: +64-3-3129-256
Fax: +64-3-3129-257
E-mail: events@donnafarhi.co.nz
Web: www.donnafarhi.co.nz
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