Yoga New Client Form
Please submit BEFORE your first yoga class.
Please note, all the information on this form is kept strictly confidential.
Email address *
Full Name *
Date of birth *
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Gender *
Emergency contact name and number *
Have you attended a yoga class before? *
If yes, how long have you practiced yoga?
If yes, what style of yoga have you practiced? (if known)
What is/are your main reason(s) for wanting to practice yoga? *
Required
How did you hear about us? *
Do you participate in any other physical activity? *
Required
How regularly do you participate in the above activities? *
Health and Medical Information
The following information is required to ensure your safety. Whilst yoga may be practised safely by the majority of people, there are certain conditions which require special attention. If you are unsure, please consult your GP before commencing class.
Please tick the boxes below if you have any of the following medical conditions. These conditions require specific modifications to your yoga practice. *
Required
Please tick the boxes below if you have any of the following medical conditions. These conditions may affect your practice and thus provide useful information for your instructor. *
Required
If you ticked any of the boxes above for the last two questions. Please give more details below.
Are you / could you be, pregnant, or have you given birth in the last six weeks? *
Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by yoga practice? *
If yes, please give more details.
Have you had any recent operations (in the last two years)? *
If yes, please state what the operation was.
If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body and respect its limits on any given day.
DECLARATION
I, the undersigned, confirm that the above information is correct and understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I will not perform any postures to the extent of strain or pain.
I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class. I understand that it is my responsibility to:

• Check with my doctor if I have any difficulties or concerns about my ability to participate in the yoga classes.
• Advise the yoga instructor of any change in my medical information.
• Follow the advice given by my doctor.

By printing your full name below and ticking the box you are submitting your electronic signature.
Full Name *
Date *
MM
/
DD
/
YYYY
Signature (Ticking the box below will be recorded as your signature) *
Required
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