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Health & Registration Form

Birthday
Day
Month
Year
How did you hear about classes?

Medical History

Do you have any of the following conditions?
Are you currently taking any medications that may affect physical activity?
Do you experience pain, dizziness or shortness of breath during physical activity?

Lifestyle & Goals

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.

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