Facility Partner Application Form

Facility Details

Facility Name*

Facility Address*

Street Address Address Line 2 City Province Postal Code

Contact Name*

First Last

Contact Position*

Contact Phone*

Contact Email*

Alternate Contact # 1 Name*

First Last

Alternate Contact # 1 Phone*

Alternate Contact # 1 Email*

Alternate Contact # 2 Name*

First Last

Alternate Contact # 2 Phone*

Alternate Contact # 2 Email*

Type of facility*

Please let us know if your facility serves any of the following Corrections, Mental Health, Addictions, At-risk Youth, Women who have experienced violence, Seniors, other please specify.

Overview of clients being served.*

Please provide age range, estimated number of clients yoga program would be available to, expected attendance numbers, gender etc.

Overview of clients challenges*

Please give an overview of particular challenges/special needs of students (eg. Addictions, prenatal, mental health, etc.) This information will be shared with teachers who are interested in applying to teach at your facility so please make it as full and clear as possible.

Facility overview - please provide a profile of your facility including mission, clients served, values, etc.*

Again, this profile will be shared with teachers who are interested in applying for volunteer teaching positions at your facility so please take the time to make it as full and clear as possible.

Please explain why your facility has decided to begin/resume a yoga program and the benefits you hope yoga will have for your clients.*

Are there any special requirements for volunteering at this facility?*

We require all volunteers to complete a criminal records check however please let us know if you require anything else ie vulnreable persons check, medical test or immunizations, male or female volunteers etc

Please explain how clients will be referred to the yoga program at your facility and how you plan to promote the class and make it as accessible as possible.*

Yoga Outreach does not provide classes in facilities where clients are required to pay for classes.*

Yoga Outreach asks facility partners to contribute financially on a sliding scale.*

Please indicate the amount you are able to pay/class.

Will a staff member be in attendance at each class?*

Has there ever been a yoga program at your facility?*

If your answer was yes to the previous question please provide details about the program and why it was discontinued.

Preferred days and times for classes*

Please give as many options as possible to accommodate limited volunteer availability.

Please give details of your preferred class scheduling.

For example: weekly, byweekly, monthly or sessional (ie, 8 week session with a break before the next one begins)

What kinds of support are available for clients at your facility? Do clients have access to a counsellor of other professional?*

Please give details.

Does your facility carry Commercial General Liability insurance that will cover the volunteer yoga teacher to provide yoga classes for clients?*

Please note we ask all of our volunteers to carry liability insurance to cover them in the practice of teaching yoga. Your insurance would only need to cover the volunteer if something happened to them while on site.

Yoga Outreach will provide props for your classes provided you have a secure storage location for them.*

Yoga Outreach does not provide cleaning supplies for the mats, will you be able to make sure mats are cleaned appropriately between classes?*

Spray bottles with a mild solution of vinegar and water can be used with paper towels to clean the mats after class. Students can be asked to take responsibility for this task.

As part of a commitment to ongoing yoga programming at your facility we require that you collect regular feedback from students and well as keeping track of weekly attendance statistics.*

Please note it is a YO program requirement that we receive regular input from both clients and facility staff . If your facility is consistently unable to meet this requirement we may discontinue support of your YO program.

If you answered no to the previous question please explain.

Once you have submitted this form someone for YO will contact you shortly to discuss your needs.*

Please note that once YO has accepted your application we request that you do not solicit others to teach yoga at your facility. YO will invest significant resources in getting a program started for you and we appreciate your support.