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Yoga Registration Form -
All information is strictly confidential.
First name *
Last name *
Mobile: *
Email: *
Emergency Contact Name: *
Telephone: *
Age Range: *
Occupation: *
Have you done Yoga before? *
Required
If yes, what type and how long ago?
Do you have a history that includes any of the following?
Please provide details. Are you taking any medications? Is there anything else that is not included above that we should know? Are there any movements that may cause you difficulty?
AGREEMENT: I understand that I am responsible for my own health and wellbeing. During the class I will listen to my own body. I will not do any practice that I believe is not suitable for my body or current state of mind at any particular time. If I have any doubts I will ask for modification. I will consult my doctor on any health concerns. *
Date: *
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