Please complete this form prior to attending your first class. Thank you
Emergency Contact Details (Mobile)
17 - 34
35 - 44
45 - 64
Have you practiced yoga before
Which aspects of yoga interest you the most
Improve health and wellbeing
A bit of 'me time'
Other (Please state below)
Do any of these health conditions apply to you?
High blood pressure
Low blood pressure/fainting
Detached retina/other eye problems
If you answered yes to any of the conditions above, please give details
Do you have any other conditions, which affect your mobility or are likely to cause you concern when doing Yoga? If Yes, give details:
How did you first hear about this class?
Confirm your responsibility
- I take full responsibility for my health during the yoga classes. I will inform my yoga teacher of any medical changes.
Confirm information is correct
- I confirm that all information provided above is correct and up to date to the best of my knowledge
Your information will not be shared with any 3rd party entities.
indicates required fields