New Yoga Central - Class Reg & Health Form

Yoga Central - New student class registration

Looking forward to welcoming you to class. Please complete the below to ensure I have all the health information required and to confirm that you agree to the class T&Cs.
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Emergency Phone Number

Area CodePhone Number
How did you hear about the class?

Web SiteFriend/ColleagueFacebookOther
Have you done yoga before or are you a beginner?
Do you have any health issues I need to be aware of? Please include aspects like recent injuries, back issues, ligament, muscle issues, blood pressure issues, epilepsy, dizziness, heart issues and anything else that impacts your health and movement.
Are you pregnant or have you recently given birth?
Please tell me what you are looking to get out of your yoga practice.
HEALTH DISCLAIMER

I have been advised and understand that participation in yoga as in any other exercise activity presents some unavoidable risk of injury, especially to people who have pre-existing injuries, illnesses or health problems.

I also understand that a medical evaluation is advisable before commencing any programme of physical exercise. I have and will continue to keep Yoga Central informed of any physical condition or disability which may prevent or limit my participation in classes. I acknowledge that although the classes may have substantial physical benefits, my instructor is not engaged in diagnosing of treating medical conditions or diseases.

I expressly assume all risks of my participation in the yoga classes and waive any claim which I might otherwise bring against my yoga instructor as a result of injuries relation to my participation in these classes.

I confirm that all the information provided in this questionnaire is true to the best of my knowledge and I am not aware of any reason why I shoud not participate in the yoga classes, if the teacher accepts me.
I have read the above and agree and my agreement acts as my signature.
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Yoga Central - New student class registration