Ashé Yoga Student Form
Getting to know you better allows me to serve you well. Please fill out this brief form so I may properly support you in your goals. This information will only be used to support your practice, will not be shared with ANYONE, and will be held in the strictest of confidence.
Name *
Email *
Address *
Phone Number *
Texts OK? *
Want to receive emails and updates from Ashé Yoga about upcoming workshops, retreats, and trainings? *
DOB
MM
/
DD
/
YYYY
Emergency Contact (name, #) *
How did you find me? *
If you responded friend or other, please explain
Occupation *
Yoga Experience & Goals
Have you practiced yoga before? For how long? *
How often do you practice yoga? *
How would you describe your yoga practice? *
What styles of yoga do you practice most frequently? (check all that apply) *
Required
What styles of meditation do you practice most frequently? (check all that apply) *
Required
What are your goals/expectations for your practice? What benefits are you looking for? (check all that apply) *
Required
If other, please explain.
What are your personal yoga interests? (check all that apply) *
Required
If other, please explain.
Lifestyle and Fitness
How do you rate your current level of activity? *
relatively inactive
very active
How do you rate your current level of stress? *
minimal stress
excessive stress
Please list any previous or current injuries and/or concerns, how long ago the injury occurred, and where are you in your recovery: *
A Note from Your Instructor
I am delighted to have you as a yoga student. The preceding information will help you get the most out of your session and clarify our instructor/student relationship.

I believe that Yoga is more than physical exercise. It is a transformative practice that integrates body, mind and emotional tensions to arrive at deeper levels of relaxation and awareness. Though rare in yoga, all programs with a physical element involve a risk of injury. By choosing to participate in a session, you voluntarily assume a certain risk of injury. Body awareness is fundamental to the practice of Yoga. I commit to always keep your well-being as my priority.

A G R E E M E N T

By attending this session, I affirm that I am solely responsible for my health and well-being, as well as my decision to practice yoga, a program of physical exercise. I agree to inform Tamika R. Caston-Miller of any activities or movements that I feel could cause injury to myself. I agree to tell Tamika when I am injured or under-nourished. I understand that yoga is not recommended or safe under certain medical conditions. I will confirm that I do not have any physical conditions or disability that would preclude my participation in this practice with a medical professional. Tamika R. Caston-Miller, operating as Ashé Yoga, shall not be held liable for any injury, loss or damage to property and/or persons sustained during or as a result of participation in this program. I agree to listen to my body and monitor myself during every class session.

I have read the above and will abide by the agreement. *
By typing your name here, you are electronically signing this form. *
Current Students Only
If you currently practice with Tamika and haven't yet left a testimonial, please include one here if you feel so inclined. Thank you!
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