Hata Yoga Registration Form
Please fill in the information below. This information will allow us to ensure that you can make the most of the program. All personal information will remain strictly confidential.
Program Attending *
Required
Name *
Your answer
Last Name *
Your answer
Name you prefer to be called
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Phone Number *
Your answer
Email Address *
Your answer
Residential Address
Your answer
Education Qualification
Your answer
Occupation *
Your answer
Emergency Contact Name, Relationship and Phone Number *
Your answer
Please give details of yoga or meditation you have practiced and how long you have been practicing *
Your answer
Have you participated in any Isha Yoga Programs? *
If yes, please give details below (Program and Year)
Your answer
How did you hear about the program
Your answer
What do you hope to achieve from this Program?
Your answer
Please indicate below if you currently or previously have had any physical or mental ailments.For Ex. Hernia, Neck or Back disease, Dislocations, Joint replacements, Injury, Depression, Anxiety etc. Please give details of the nature and duration of the condition and if you are currently undergoing any treatment: *
Your answer
Have you had any major surgery in the last six months? *
For Women: Are you currently pregnant?
Weight (Kg) *
Your answer
Height (cms) *
Your answer
I hereby willingly undertake to attend this program completely. I take full responsibility for the result and indemnify the organizers against all claims and suits. I will not communicate the contents of the program, either directly or indirectly to anyone else. I understand the participation guidelines and agree to follow them. I hereby declare that the above information is true, accurate and complete to the best of my knowledge. *
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