Registration & Health Screening Form

Name

First

Last

Email

Phone

Home address including postcode

Age or date of birth (optional)

Occupation (optional)

Do you have any of the health conditions listed below? Please tick all that apply.

Do you have any conditions not listed above that might impact your yoga practice? If yes, please specify.

Would you describe your yoga experience so far as: complete beginner, beginner, intermediate or advanced?

If you have practiced yoga before, what style of yoga was it? (optional)

What is your primary goal for taking up yoga?

Do you have your own yoga mat? If not, I will bring one for you.

Yes I have my own mat.

No I don’t have one.

How did you find out about this course or class? Please tick all that apply. (optional)

By submitting this form: (1) I acknowledge that yoga is not a substitute for a doctor’s advice or medical treatment; (2) I take full responsibility for my health during my yoga practice; (3) I confirm that I have disclosed all information regarding my health as relevant to the practice of yoga and I agree to notify you of any future changes. PLEASE TYPE YOUR FULL NAME BELOW. Thank you.

PRACTICE WELLNESS

Registration & Health Screening Form

Please complete before attending your first class.

I will handle and protect your personal information sensitively in line with Data Protection Act 2018 and General Data Protection Regulation (GDPR). Learn more in my Privacy Policy.

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PRACTICE WELLNESS

Please complete before attending your first class.

I will handle and protect your personal information sensitively in line with Data Protection Act 2018 and General Data Protection Regulation (GDPR). Learn more in my Privacy Policy.

Hello Thanks for being here!

Sign up to receive my blogs straight into your inbox.

Hello
Thanks for being here!