Name *
Name
Phone *
Phone
Phone number with country code
DOB *
DOB
Date of Birth
Is there is anything that will affect your yoga class. old injuries, medical conditions etc. Please select the relevant and give details below. If you are fit and healthy please type N/A below.
Has your doctor recommended you refrain from any particular kind of exercise? Yes / No *
Asthma
High or Low Blood Pressure
Arthritic joints
Heart Condition
Back, neck, shoulder, knee issues
Joint replacement
Diabetes
Recent surgical Procedure
Epilepsy
Eye or Ear condition
Pregnant or given birth in the last 6 months
What would you like to achieve from your yoga class?
Emergency Contact Name (Not you!): *
Emergency Contact Name (Not you!):
Emergency Contact Tel (Not you!) *
Emergency Contact Tel (Not you!)
Disclamer *
By checking this box you take full responsibility for your own well being during your yoga practice and understand that yoga like any other form of physical exertion has inherent physical risks. If you have any health issues, you have mentioned them above and got the all clear from your Doctor. ** If under 18 a parent or guardian consents to them taking part in this practice. **
Name of Guardian if relevant.
Name of Guardian if relevant.