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?
Yes
If yes, when are you due? Any complications with current pregnancy? Any complications with previous pregnancies?

Do you take any medications?
YesNo
If yes, please describe the condition for which it is prescribed?

Have you ever injured or currently have pain in any of the following areas of your body?
HeadNeckBackTorsoShouldersArmsHands/Wrists/FingersHipsUpper LegsKnees, Lower LegsAnkles/Feet
Is there any reason why you should obtain a medical clearance from your doctor?

"I agree that I take all responsibility for my own injury that may happen, in the unlikely event that it does (notwithstanding all the care and skill that I acknowledge that the yoga studio will provide)". *
I agree

Thank you for your registration, we look forward to sharing yoga with you. We will send an email confirmation of your registration along with a receipt with any online purchase.

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