Yoga Class Registration Form

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Full Name *

Gender *

Male

Female

Date of Birth *

Phone Number *

Email *

Residential Address *

Select Program *

Yoga Class Level - 1 ( Beginner)

Yoga Class Level - 2 ( Intermediate )

One - on - One Private Class

Pranayama & Meditation

Select Timing

Morning - Beginner ( 8.30 to 9.30 am)

Evening - Intermediate (Monday - Thursday, 5.00 to 6.00 pm)

Pranayama (Friday, 5.00 to 6.00 pm)

Not applicable for Private session

Clear selection

Have you practiced yoga before? *

Yes

If YES in the previous question, for how long? *

Receive updates about Retreat/workshops? *

Yes

Required

Medical Background

Please select the word that best describes your current state of health. *

Great

Good

Fair

Poor

Are you currently on Medication? *

Yes

If YES in the previous question, please describe. *

Are you affected by any of the following? *

Heart problem of any type

Asthama

Diabetes

Chronic Pain

High Blood Pressure

Low blood pressure

Epilepsy

Back injury

Headache

Arthritis, bone or joint problem

NONE of the above

Required

If yes in any of the above, please describe. *

Have you recently- *

Attended physical Therapy

Had any surgery

None

If yes in any of the above, please describe. *

Please describe in detail, any other health or medical condition that you believe may be helpful to your Yoga teacher to know. *

Declaration *

I am aware that fitness activities involve a risk of injury and I give my consent that I am voluntarily participating in this online yoga class. I will inform to the Teacher of any changes in my body prior to each class. I state that I am not suffering from any major diseases that may lead to critical care. The information I have provided on this form complete and accurate.

Agree

For the above checkbox.

Signed as: (Your name)

Submit

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