Hāora Healing Client Registration
All information given on this form will be treated as confidential
Which Class, Course or session are you Registering For?
General Yoga Classes
Private Yoga Class
Womens Healing Session
Date of Birth
Street or PO Box
Registering signs you up to our newsletter, you can unsubscribe at any time.
Preferred contact phone number
Mobile phone number
How did you find out about us
Newspaper advertisement or print media
Name of friend
Are you pregnant
If yes how many weeks pregnant?
What is your due date
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.
Please indicate if you have suffered any of the following conditions:
Please tick as many as apply
Gynecological or Menstrual Disorders
Low Blood Pressure
High Blood Pressure
Arthritis please indicate what type in Other
Hernias please indicate what type in Other
Cancer please indicate whay type in Other
Other conditions or longer explanation of listed medical conditions
If you are taking any medications please state and advise for which condition:
Emergency Contact Details
Relationship to you
Telephone number home
Telephone number work
Contact Mobile Number
Yoga is a physical activity, and Reflexology and Hāora Healing are physical bodywork treatments. Reflexology & Hāora Healing do 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/treatment session I am attending. I will notify the practitioner/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 yoga class or in receiving reflexology or Hāora Healing. Yoga courses, classes and workshops are not suitable for any stage of pregnancy.
Yoga, Reflexology and Hāora Healing sessions can bring up feelings and emotions that can be challenging to the individual. Yoga, Reflexology and Hāora Healing sessions do not cure, diagnose or treat any illness or medical, emotional or psychological condition.
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, Reflexology and Hāora Healing 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 yoga practice according to my limitations and the decision to perform any exercise remains mine. I expressly waive any claim against Jo Vernon, Hāora Yoga & Holistic Health and other teachers/practitioners representing and teaching for Hāora Yoga & Holistic Health, for any injury or loss sustained while undertaking Yoga, Reflexology, or Hāora Healing under their instruction.
I confirm that I am over 18 and have read and accept the safety disclaimer above
I am the parent or guardian of the applicant and I accept the safety disclaimer on their behalf
Parents Full Name
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.
Please insert your name as a reference if paying by direct credit.
JM Vernon BNZ Lower Hutt
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 Hāora Yoga & Holistic Health 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 Hāora Yoga & Holistic Health a full refund will be given.
Please see our website for terms and conditions for general class concession cards.
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