Please complete this form prior to attending your first class. Thank you

Name * Email * Phone Number * Emergency Contact * Emergency Contact Details (Mobile) * Age Group Under 1617 - 3435 - 4445 - 6465+ Have you practiced yoga before YesNo

Which aspects of yoga interest you the most

Physical Postures Relaxation Breathwork Meditation Chanting Improve health and wellbeing A bit of 'me time' Other (Please state below)

Details

Do any of these health conditions apply to you?

High blood pressure Low blood pressure/fainting Arthritis Diabetes Epilepsy Heart problems Asthma Anxiety Depression Detached retina/other eye problems Recent fractures/sprains Recent operations Back problems Knee problems Neck problems Recent pregnancies Currently pregnant

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.

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