Registration for classes

Registration for yoga classes:

* Indicates required field

Name *

First

Last

Address *

Suburb *

State *

Post Code *

Phone *

Email *

are you pregnant?

> *

Yes No

Partner's name (or emergency contact) *

Phone *

pregnancy/birth information

If you are pregnant, what is your estimated due date? *

Health and Previous Yoga Experience

Have you practised yoga before? *

Yes No

Have you ever had or do you have any of the following? If yes, please give details:

High blood pressure *

Yes No

Details *

Low blood pressure/fainting *

Yes No

Details *

Arthritis *

Yes No

Details *

Diabetes *

Yes No

Details *

Epilepsy *

Yes No

Details *

Heart/Stroke condition *

Yes No

Details *

Asthma/Breathing Difficulties *

Yes No

Details *

Depression *

Yes No

Details *

Detached retina/other eye problems *

Yes No

Details *

Recent fractures/sprains *

Yes No

Details *

Recent operations/injuries *

Yes No

Details *

Back problems *

Yes No

Details *

Knee/ankle problems *

Yes No

Details *

Neck/shoulder pain *

Yes No

Details *

Cautions - If you have a history of miscarriage, do not practice yoga before you are 12 weeks pregnant. If you experience any bleeding during your pregnancy, avoid yoga until it has ceased. Please inform us if you have any injuries or health concerns. During the class listen to your body and come out of poses if necessary. Listen to instructions carefully, remember that yoga is non-competitive and always let common sense prevail. *

I have read the above cautions and answered all the questions to my satisfaction. I hereby waive the right to all and any claim against the teacher for any injury or adverse change in my state of health arising directly or indirectly from my participation in classes. I will inform my yoga teacher of any medical changes.

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