registration form

These questions help us to know more about you and your body and health conditions, if any. It is important that your teacher is aware of any medical conditions, past or on-going maintenance of injuries, so that postures can be modified or substituted as necessary.

* Indicates required field

Today's Date *

First Name *

Surname *

City/Suburb *

Phone Number *

Email *
Occupation

Which Class or Course are you booking in to? (Include Date of course or Day and Time of Class) *

Emergency Contact - Name & Relationship *

Emergency Contact - Phone *

How did you find out about the class? Facebook, Instagram, Word of mouth, Walking by, Email, Flyer, (or describe) Other?

How much yoga have you done before?

What are your reasons for starting yoga?

Do you have any of the following medical conditions?
Back problems; lower, middle, upperSpinal disc injuryRecent surgeryHigh/Low blood pressure (are you on medication?)Knee problemsAnxiety or DepressionMigraines or Tension Headaches/Whiplash injuryArthritis Osteo/Rheumatoid/LupusMenopausal symptoms or Menstruation problemsAnything else that may need special consideration in class?


If you answered YES to any of the above, please specify your condition and give further detail if required

Are you pregnant?