Clear Skies Yoga - New Student Registration Form
Please note that the data you enter is considered completely private and confidential. By completing this form you consent to being contacted by Clear Skies Yoga regarding yoga classes and events within Brisbane and it's surrounds. You may unsubscribe from these updates at any time. Your information will not be provided to any third parties.
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First Name
*
Your answer
Surname
*
Your answer
Email
*
Your answer
Date of Birth
MM
/
DD
/
YYYY
Phone (home)
Your answer
Phone (mobile)
Your answer
Street Address
Your answer
Suburb
Your answer
Emergency Contact Name & Phone Number
*
Your answer
How did you find out about the class?
*
Please try to be specific
Letterbox flyer
Friend (please add your friend's name below for the Refer a Friend program)
Facebook (if shared by a friend, please advise their name below for the Refer a Friend program)
Google search
FindYoga
Internet (please list website below)
Yoga Teacher (please add your teacher's name below)
Street sign
Other:
Required
Have you practiced yoga before?
Yes
No
If you have practiced before what style/where?
Vinyasa/Flow/Power
Hatha
Bikram
Yoga in Daily Life
Pregnancy
Other:
Please list any current conditions or areas of concern.
Ankle
Knee
Shoulder
Low Back
Wrist/Carpal Tunnel
Neck
Pregnancy (please list due date below)
Hypermobility
Depression/Anxiety
Other:
Please provide us with some more information about your condition or your due date if you are pregnant.
Your answer
What are you looking for in your yoga and meditation practice?
Relaxation
Strength
Flexibility
Philosophy
Breathing techniques
Meditation
Other:
By checking the box below you agree that you understand that the advice given in your yoga class is in no way considered medical advice. You must inform your teacher verbally of any conditions prior to practice, and you agree to take responsibility for your own physical, emotional and mental wellbeing during class. You agree to practice with common sense, and to discuss any concerns with your teacher after class.
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Check this box to confirm that you have read and agreed to the conditions outlined above.
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