YogaBliss Student Questionnaire
Name
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Phone Number
Your answer
e-mail
Your answer
Is this your first class at YogaBliss?
Which Class/Date would you like to register for?
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Are you new to Yoga?
Would you like to be added to our Newsletter to receive info on class updates, workshops and retreats?
Do you have any of the following medical or health conditions:
Any serious illness or other health concerns
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*PROFESSIONAL DISCLOSER AND RELEASE
All exercise programs involve a risk of injury. By choosing to participate in my yoga classes, you voluntarily assume a certain risk of injury. The following guidelines will help you reduce your risk of injury:
Listen to and follow my instructions carefully.
Breathe smoothly and continuously as you move and stretch.
Do not hold your breath or strain to attain any position.
Work gently, respecting your body’s abilities and limits.
Don’t perform postures or movements that are painful.
Ask me if you are unsure how to perform a certain movement.
Menstruating women should not practice inverted postures.
Pregnant women must consult their health care provider before enrolling in class.
It is always advisable to consult your physician before embarking on any exercise program.
Awareness is fundamental to the practice of Yoga. It is your responsibility as a student to monitor each activity and determine whether it is appropriate for you to participate. Though I am your teacher, you remain primarily responsible for your safety and well-being.
As a professional, I am responsible for providing competent yoga instruction. I am not responsible for ensuring the safety of my students beyond providing competent instruction. By signing this form, you hereby release Nienke Young and the YogaBliss Teachers and The Studio of YogaBliss from any and all liability for injuries that are not directly and proximately caused by my professional negligence.
PLEASE READ THE STATEMENT ABOVE AND TYPE YOUR NAME TO APPROVE
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