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YOGA CLASS WAIVER FORM
Yoga with Valeria Piccioli, Radiant Body Yoga Teacher
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Please select the service/s of interest
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1-1 Personal Yoga
1-1 Personal Yoga & Coaching
Yoga Group Class - Village Hall, Butlers Cross, Bucks
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First Name
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Your answer
Last Name
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Your answer
Email
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Your answer
Emergency Contact Name
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Your answer
Emergency Contact Number
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Your answer
Have you practised yoga before?
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Yes
No
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If yes, please give details
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Your answer
Please describe any injuries or movement limitations you are aware of
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Your answer
Do you experience any pain or numbness in these areas, please check any that apply:
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Neck
Shoulders
Elbow
Hands
Wrist
Hips
Lower back
Upper back
Knees
Feet
Other:
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