Pre-Yoga Class Questionnaire

First name: *

Last name: *

Your e-mail address: *

Please make sure you've typed this correctly

Your phone number: *

Emergency contact name and phone number: *

Please give details of any other physical activity you do:

Yoga is safe for the majority of people, however there are certain conditions which require special attention. If you're not sure please consult your GP beforehand. To help me ensure your safety when practising yoga, please tick any boxes below that apply to you:

Are you pregnant, could you be or have you given birth in the last six weeks? *

Yes

No

Please give details of any injuries that could affect your ability to practice yoga:

Please tick below to confirm that the information you've provided is accurate, that you agree it's your responsibility to check with your doctor if you have any concerns about practising yoga and that you are responsible for notifying me if any of this information changes: *

I confirm the information is correct

Would you like to receive occasional e-mails with updates and offers? *

Yes

No

This form collects and stores your details in line with our privacy policy and only for the purposes stated.

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Pre-Yoga Class Questionnaire

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