New student form - health
We need to gather some information from you. The reasons for this are to a) safeguard your health and safety, b) it's a professional insurance requirement and c) for contractual purposes. Your data is kept on the cloud and is reviewed yearly, finally being deleted after 7 years. If you prefer you can print the form and let me have it as a hard copy. For more information please see the Viveka Gardens Privacy Policy on vivekagardens.com.
Email address *
name *
Your answer
mobile and/or landline (both preferred)
Your answer
Name, day and time of class (eg gentle Tues 6pm) or in the case of 1-1, write 1-1 *
Your answer
How did you hear about Viveka Gardens or this workshop *
emergency contact name and number - by adding this info you confirm you have the consent of the contact *
Your answer
previous yoga experience (briefly) *
Your answer
what do you hope to gain from the classes? *
Your answer
Please let us know if you are affected by any of these. Please be in touch if you'd like to talk it over. *
Please give details or add anything else you think we should know about. *
Your answer
Please tell us about any food allergies (write 'none', if none) *
Your answer
Payment details
I agree to a pre-session consultation on the phone or by video link before taking part in online sessions. I agree to take full responsibility for myself and for my personal property. The decision to participate in the activities is my own responsibility. In addition, I agree that I will not hold Viveka Gardens responsible for any injuries or damages that might result from my participation in any of the activities. 'Sign' by typing your name and date *
Your answer
Thank you. Now please LET US KNOW you have completed the form and sent payment, using this email, fiona.law{at}hotmail.co.uk. See you soon. Om Shanti.
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