Hutt Yoga & Hutt Holistic Health Student/Client Registration
All information given on this form will be treated as confidential
Which Class, Course or session are you Registering For? *
First Name *
Your answer
Last Name *
Your answer
Company Name
If booking for Workplace Yoga sessions or classes
Your answer
Date of Birth *
Your answer
Mailing Address
Street or PO Box
Your answer
Email Address *
Registering signs you up to our newsletter, you can unsubscribe at any time.
Your answer
Preferred contact phone number
Your answer
Mobile phone number
Your answer
How did you find out about us *
Name of friend
Your answer
Medical Information
Are you pregnant *
If yes how many weeks pregnant?
Your answer
What is your due date
Your answer
If you have recently had a baby please state how long postpartum you are
General Classes and Beginners Course are suitable when you are at minimum 3 months post partum, if you had a cesarean or complications please state in the medical conditions section.
Your answer
Please indicate if you have suffered any of the following conditions:
Please tick as many as apply
Other conditions or longer explanation of listed medical conditions
Your answer
If you are taking any medications please state and advise for which condition:
Your answer
Emergency Contact Details
Contact Name *
Your answer
Relationship to you
Your answer
Telephone number home
Your answer
Telephone number work
Your answer
Contact Mobile Number
Your answer
Safety Disclaimer
Yoga is a physical activity, and Reflexology is a physical bodywork treatment. Reflexology does not cure, diagnose or treat any illness disease or condition. As with any physical activity, body work or exercise programme, the risk of injury, even serious or disabling is present. I confirm that I understand that I am expected to work within my limits and be responsible for my own health and safety during all components of the class/session I am attending. I will notify the teacher before each class/session begins of any recent injury, illness, surgery or of any circumstance medical or otherwise that could prevent me from participating safely in the class. Courses, classes and workshops are not suitable for any stage of pregnancy.

Wahine Aura, Colour Therapy, Reflexology and Solistry foot readings can bring up feelings and emotions that can be challenging to the individual. Wahine Aura, Colour Therapy, Reflexology and Solistry foot readings do not cure, diagnose or treat any illness or medical, emotional or psychological condition. During Solistry foot readings you may also be given reflexology.

To reduce the risk of injury through the practice of yoga, never force or strain, if you feel pain, discomfort or dizziness, discontinue the practice. Yoga is not a substitute for medical attention, examination or diagnosis. Yoga and Reflexology are not recommended and are not safe under certain medical conditions. Consult your doctor before beginning this or any exercise programme or body work treatment.

To ensure that no personal injury occurs, I agree to adjust my practice according to my limitations and the decision to perform any exercise remains mine. I expressly waive any claim against Jo Vernon, Hutt Yoga & Holistic Health and other teachers representing and teaching for Hutt Yoga & Holistic Health, for any injury or loss sustained while undertaking Yoga, Reflexology, Solistry or Wahine Aura under their instruction.

Acceptance *
Parents Full Name
Your answer
Payment Details
We will send you an invoice on receipt of your registration for a workshop. course, consultation or treatment.

Payment for courses and workshops confirms your registration and is due within 7 days of booking.

If your booked course or workshop is commencing within 7 days of your registration date, payment is due within 1 day of booking.

Payment Methods

Direct Deposit:
Please insert your name as a reference if paying by direct credit.

Hutt Yoga BNZ Lower Hutt

Credit card

The invoice you will receive after registration includes an option for payment by credit card.

Course and Workshop Refund Policy:

No credits or refunds are given on withdrawn or missed classes once the course has started.

If cancelled 7 working days prior to the course commencing a $20 administration fee will apply. No refunds will be given for cancellations made within 6 working days of course commencement.

If a class within a course is cancelled by Hutt Yoga a refund will be given for that class or an extra class will be added to the course, if you are unable to attend the extra class, a pro rata refund will be given for the cancelled class. If a full course or workshop is cancelled by Hutt Yoga a full refund will be given.

Please see our website for terms and conditions for general class concession cards.

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