ขอสิทธิ์แก้ไข
Pranasana Yoga
HEALTH  FORM
อีเมล *
Name *
Date of Birth *
วว
/
ดด
/
ปปปป
Address *
Email Address *
Telephone Number *
Emergency Contact Name *
Emergency Contact Tel. No. *
If 'Yes' how long ago and what kind of practices did you do?
The following information is required to ensure your safety. Whilst yoga and tai chi may be practised safely by most people, there are certain conditions which require special attention. If you are unsure, please consult your GP before commencing class. Please tick the boxes below if you have any of the following medical conditions. These conditions require specific modifications to your yoga practice. If yes, please give details.
These conditions may affect your practice and so please provide useful information to your tutor.
Further Information
Please tick the box if you do not wish to declare medical information
Have you had any recent operations (in the last two years)?
ล้างสิ่งที่เลือก
If yes to 'recent operations' add further relevant information below.
Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by yoga or tai chi practice?
Are you /could you be, pregnant, or have you given birth in the last six weeks?
ล้างสิ่งที่เลือก
Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other?
How regularly do you do this?
How did you hear about us? *
Declaration ~ I confirm the above information is correct and that I take responsibility for my own health and safety whilst participating in yoga/tai chi classes with Pranasana Yoga. I understand that it is my responsibility to check with my doctor if I have any difficulties or concerns about my ability to participate in the sessions. I will advise the yoga/tai chi tutor of any change in my medical information or ability to participate in the yoga/tai chi sessions and will follow the advice given by my doctor and/or yoga/tai chi tutors to the best of my ability.  I understand that Pranasana Yoga are not responsible for my actions and decisions during the sessions. *
If you would like to hear about more of our events please say "Yes! :)"
ล้างสิ่งที่เลือก
To comply with the General Data Protection Regulations, are you happy for us to contact you? *
จำเป็น
Name/Signature *
Date *
วว
/
ดด
/
ปปปป
ส่ง
ล้างแบบฟอร์ม
ห้ามส่งรหัสผ่านใน Google ฟอร์ม
เนื้อหานี้มิได้ถูกสร้างขึ้นหรือรับรองโดย Google รายงานการละเมิด - ข้อกำหนดในการให้บริการ - นโยบายความเป็นส่วนตัว
Google ฟอร์ม