LauraYoga Prenatal yoga students
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Name *
Address *
Contact Telephone Number *
Email address *
Date of birth *
MM
/
DD
/
YYYY
Due date *
MM
/
DD
/
YYYY
Have you done yoga before? *
Please give details of how long, what style of yoga, etc?
What do you hope to gain from these classes?
During this pregnancy have you experienced any of the following? *
Tick all that may apply
Required
Please give details of any of the above that you ticked and any other health issues which may effect your yoga practise *
Including any previous operations
Have you had any previous pregnancies? *
Have you had any previous miscarriages? *
Have you had any previous births? *
Do you smoke? *
Are you taking any medication that may effect your yoga practise? *
Declaration *
I understand that Laura Avery will take all reasonable care to ensure that the yoga class is safe to participate in during pregnancy. I understand that it is recommended to wait until I am in my second trimester and have had my 12week scan before I participate in any prenatal yoga class. I declare that to the best of my knowledge, the information given is correct and I know of no reason why I should not participate in a prenatal yoga class. I understand that I enter into any exercise programme at my own risk and I waive any legal recourse for damages to myself or my baby which may arise from my participation in the yoga class. Signed (initial qualifies for online form)
How did you hear about these classes? *
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