Personal Details
Name *
Email *
Phone Number *
Active Whats App Number
Date of Birth *
MM
/
DD
/
YYYY
Session *
Required
Health Condition
Weight *
Referred By:
City *
Address *
Emergency Contact Name *
Relationship with Emergency Contact *
Emergency Contact Phone Number *
How did you find us? *
Consent and Terms and Conditions *
We understand that it is our responsibility to consult a physician prior to participating in sessions. We warrant that all family members enrolled are physically fit and do not have medical conditions which would prevent us participating in sessions. We recognize the various suggested poses should be approached in a gentle fashion. If any movement brings discomfort, We know to modify the pose as deemed necessary to our physical needs. We agree to assume full responsibility for any injuries sustained to any family members enrolled. We have read and fully understand this consent and accept its contents.
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy