Yoga Student Registration
One time form to register for yoga class
Email address *
First Name: *
Your answer
Last Name: *
Your answer
Postcode: *
Your answer
Mobile phone number: *
Your answer
There has never been an emergency, but better safe than sorry...
Emergency Contact Name and number *
Your answer
Could you be Pregnant? *
Congratulations!!! What date are you due?
MM
/
DD
/
YYYY
Occupation:
Your answer
Do you have any health issues? Please select (All information is private and will remain confidential): *
Required
If you have ticked any boxes it is recommended that you check with your health practitioner before participating in a yoga class. Please discuss your condition and any special requirements you may have with your instructor before the class. You must be comfortable and pain free throughout your yoga class. If you experience pain in any of the poses, stop , rest and seek advice from your instructor. *
Required
Please give details of any of the above mentioned health conditions
Your answer
Have you practiced Yoga before? Which styles and for how long? *
Your answer
Would you like to receive a updates about Saturday Classes? *
Required
I understand that the yoga instructor cannot provide medical advice. I understand that it is my responsibility to practice within my personal limits and to decide whether or not to follow the advice and guidance provided by the yoga instructor. *
Required
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