Free Yoga Class Friday 30th November
6.30 - 8pm
(The Wilson Dance Studio)
Email address *
Name *
First and last name
Your answer
Phone number *
Your answer
How long have you been practicing yoga? *
Health Questionaire *
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
Do you feel pain in your chest when you perform physical activity?
In the past month, have you had chest pain when you were not performing anyphysical activity?
Do you lose your balance because of dizziness or do you ever loseconsciousness?
Do you have a bone or joint problem that could be made worse by a change inyour physical activity?
Is your doctor currently prescribing any medication for your blood pressure orfor a heart condition
Do you know of any other reason why you should not engage in physicalactivity?
Do you have any other injuries or medical conditions we should be aware of?
If you have answered “Yes” to one or more of the above questions, consult your doctor before engaging in this physically active course. Tell your doctor which questions you answered “Yes” to. After a medical evaluation, seek advice from your doctor if this course is suitable for your current condition and consult with Emily. Please give details of any injuries or medical conditions we should know about below:
Your answer
Emergency contact details : Name and contact number. *
Your answer
I have read and Agreed with the YTTC Terms and Conditions ( available at *
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