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 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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