Please complete and submit before you take part in an online class.
So that we can look after you in class
Name, Address, Email, Phone Number *
Your answer
Would you like to receive the monthly email informing of programs, workshops and offers? *
Have you attended a yoga class before? If yes, how long/what style of yoga have you practiced? (if known) *
Required
Do you have a home practise? *
Required
How did you hear about this class? *
Your answer
Why do you want to do yoga? For what reason/what interests you? *
Your answer
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. *
Required
Is there any further health information you think we should know?
Your answer
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 provide details.
Your answer
Have you had any recent operations (in the last two years)? Yes/NoIf yes, please advise what the operation was
Your answer
DECLARATION - Please tick this box if you do not wish to declare medical information *
Required
I confirm the above information is correct. 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 class, advise the yoga tutor of any change in my medical information, follow the advice given by my doctor and/or yoga tutor. *
Required
Signed and dated *
Your answer
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