To be filled in when joining yoga class. All information given will be treated in the strictest confidence.
ZIP / Postal Code
Have you attended a yoga class before?
If yes, how long have you practiced yoga?
If yes, what style of yoga have you practiced?
How did you hear about this class?
How would you describe your general health?
Do you participate in any other physical activity?
Whilst yoga may be practised safely by the majority of people, there are certain conditions which may affect your practice and require special attention/modifications. If yes to any of the following, please give details. If you are unsure please consult your GP before commencing class.
Please check any of the following answers that apply to you.
arthritis (osteo or rheumatoid please state)
high blood pressure
low blood pressure
auto-immune disorder (e.g. M.E. M.S. Lupus etc)
sensory disorder affecting eyes or ears
balance affect. disorder
any recent operations (in the last two years)
any old injuries
are you/could you be pregnant
Details incl. medication
I confirm the above information is correct. I understand that it is my responsibility to : • check with my doctor if I have any difficulties or concerns about my ability to participate in the yoga class. • advise the yoga teacher of any change in my medical information • follow the advice given by my doctor and/or yoga teacher.
I give consent for my information to be stored In accordance to the 2018 General Data Protection Regulation. I agree to be contacted where relevant with information regarding classes & Workshops.
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