Reset & Recharge Booking Form.
I am very much looking forwards to meeting you on the Reset and Recharge course. Please fill in the form the best you can. I look forwards to seeing you on your Goal Gathering Session.
* Required
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Age
16 - 25
26 - 32
33 - 40
41- 51
52 - 65
65 plus
Other:
Clear selection
Birthday
MM
/
DD
/
YYYY
Your current Yoga experience?
*
Complete Newbie
Dabbled here and there.
Intermediate level
Advanced level
Your own personal reasons for being interested in this course?
*
Relaxation
Stress Relief
Exercise
Flexibility
Pain Relief
Meditation
Advance my Yoga practice
Other:
Required
Do you have any medical conditions or injuries I should be aware of ?
Your answer
Any further information that you would like to share prior to our first consultation, so I can tailor the session to your specific needs.
Your answer
Contact number
*
Your answer
Emergency Name and contact number
*
Your answer
Preferred form of contact for 121 sessions and weekly Check in and Chat sessions.
*
Facetime
Messenger
Skype
Zoom
Whatsapp
Other:
Facebook name (to add you to the exclusive facebook group)
Your answer
I agree payment for all sessions & courses to be made in full for all courses in advance. Payment Options: Paypal -
https://paypal.me/justmimi
(please pay as friends and family) or a fee will be added.BACS transfer. Please use your full name as a reference RBS: Michelle Ramsey Sort Code: 16 13 29 Account Number: 10241242.
*
Yes
No
Waiver
LIABILITY/ STUDENT WAIVER AGREEMENT
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly.
Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Just Mimi at
justmimiuk@gmail.com
Please agree to the above waiver
*
Yes
No
Date
*
MM
/
DD
/
YYYY
Do you give consent to be added to the Just Mimi mailing list
*
Yes
No
How did you find out about the Reset and Recharge course?
*
Facebook AD
Instagram
Word of mouth
My facebook page
My website
Other:
Have you booked your sessions using the Ovatu booking system?
Yes
No
Not yet
Clear selection
Thank you
For taking the time to fill in your details, I look forwards to meeting you very soon. If you have any further questions, please do not hesitate to get in touch
Love
Just Mimi
♡
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