YOGA RETREAT APPLICATION
We're so excited you want to come on a yoga retreat with Jenny Rhodes at Aligned Yoga, LLC! Thank you for filling out this application so we may ensure this retreat is aligned for you.
Thank you for taking the time to fill out this short form. Everything you share is 100% confidential. 
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Email *
Tell us your:
First and Last Name

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Have you had previous experience with meditation? *
Have you had previous experience with breath practices/techniques of any kind? (ie: pranayama) *
If you answered yes to either question above, please explain your experience/s.
Is there is anything you'd like to add about these practices as they relate to your mental health and wellbeing?
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Have you had previous experience with yoga and if so, what kind?
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Please check any healing modalities you've experienced that have had a positive effect on your mental health and /or physical wellbeing. *
Required
Please list any healing modalities you've experienced that have had a negative effect on your mental health and /or physical wellbeing and how this affected you. *
Do you currently have, or have you ever had a substance use disorder? *
If you answered 'yes' to the previous question, please explain here
Do you have any physical conditions that would prevent you from participating in a yoga retreat or prevent you from walking/hiking more than 2 miles? *
If you checked 'Maybe' above, please explain
Do you have any mental conditions that would prevent you from participating in group activities, sharing accommodations with others or participating in meditative practices?
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If you checked 'Maybe' above, please take a moment to explain your answer
Are you now, or have you in the past 2 years, been treated for any mental conditions that require prescription medication?  If yes, please explain. *(All information you share is strictly confidential and is never used for any purpose other than to determine if our retreat is the best fit for you) *
Are you a seasoned traveler, newly exploring or a combo of both? *
Anything else you'd like to share with Jenny?
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