Health & Registration Form

First name

Last name

Email - Please ensure this matches the email address you use to book your classes

Phone

Birthday

Day

Month

Year

Address

Emergency Contact

Emergency Contact Phone

Medical History

Do you have any of the following conditions?

Are you currently taking any medications that may affect physical activity?

Yes

No

Do you experience pain, dizziness or shortness of breath during physical activity?

Yes

No

If you answered yes to any of the above, please give relevant details in confidence:

Is there anything else I should know?

You agree to notify us of any new injuries, medical conditions, or changes to existing conditions that may affect your ability to participate safely in yoga classes.

Lifestyle & Goals

What level of physical activity do you currently undertake (any other fitness classes / active hobbies etc)

What does a typical day look like for you? (e.g type of work, activity levels, sitting/standing)

What would you like to achieve from classes?

Have you done yoga before?

No

Yes, a little

Yes, a lot

Agreement & Waiver

I understand that yoga involves physical movement and participation carries some risk. I accept full responsibility for my health and wellbeing and I will inform the instructor of any changes. I agree to practice within my own limits and acknowledge that any pain associated with the movement is a warning sign that should not be ignored. I have consulted my doctor if needed to confirm my suitability for participation. I waive any claims against the instructor or venue for injury, illness or death arising from participation. I confirm that the information I have provided is accurate and that I have read and understood the above.

Agree to terms

Please sign to acknowledge that you have read and agree to the above terms.

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