Health Waiver and Release of Liability

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Please fill out this form prior to attending any Mello Flow yoga class. [Note: you only need to fill out this form once to attend as many classes as you want]

First Name: *

Last Name: *

Email Address: *

How often do you practice yoga? *

advanced: I've been practicing yoga for years and am proficient in more challenging poses

intermediate: I regularly practice yoga

beginner: I've taken a couple of classes

this is my 1st class ever

What are your primary goals for taking this class?

What other forms of activity do you do?

weight lifting

running

swimming

cycling

hiking

hiit

cross fit

tennis

other

Do you experience any of the following: *

chronic hip pain

chronic shoulder pain

chronic lower back pain

chronic neck pain

high blood pressure

vertigo

seizures

anxiety

none of the above

Required

Are you currently pregnant? *

Yes

Do you have any other health concerns your instructor should know about?

Do you have any access needs?

For example: detailed descriptions of poses due to visual impairment, or direct/specific language due to cognition.

Would you like to receive email updates about upcoming classes? *

Yes

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