Yoga Student Registration
One time form to register for yoga class
Mobile phone number:
There has never been an emergency, but better safe than sorry...
Emergency Contact Name and number
Could you be Pregnant?
Congratulations!!! What date are you due?
Do you have any health issues? Please select (All information is private and will remain confidential):
High Blood Pressure
Low Blood Pressure
Muscular Cramps / Pain
Palpitations / pain / tightness in chest
Other chronic health condition
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.
Please give details of any of the above mentioned health conditions
Have you practiced Yoga before? Which styles and for how long?
Would you like to receive a updates about Saturday Classes?
No thank you
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.
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