Yoga for Pregnancy and Birth Intake Form

Yoga for Pregnancy and Birth

Registration Form: all information is confidential
Congratulations on your pregnancy! These sessions/workshops will help you use the practice of yoga and movement to help you have an easier pregnancy and birth. Thank you for taking the time to fill out this form so I can better understand how to support you and your baby on this incredible journey.
Full Name*

First NameLast Name
I would like to register for (check all that apply)*

12 March - 16 April ~ Bloom & Empower Pregnancy Yoga Course (4 𝙨𝙥𝙤𝙩𝙨 𝙡𝙚𝙛𝙩), Wednesdays @ 18:00, chf 2407 May - 25 June ~ Bloom & Empower Pregnancy Yoga Course (6 𝙨𝙥𝙤𝙩𝙨 𝙡𝙚𝙛𝙩), Wednesdays @ 18:00 chf 280 (no class 28 May)Couples Yoga for Labor Workshop ~ Sunday, 16 February, 10:30, chf 175 per couple (4 𝙨𝙥𝙤𝙩𝙨 𝙡𝙚𝙛𝙩)Private Pregnancy Yoga sessions
Mobile Phone Number*
E-mail*
Number of weeks pregnant*
Due Date*
Profession*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Terms and Conditions
Terms and Conditions

1. The session/s must be must be paid for in advance in order to secure your space. Upon the receipt of your payment, you will receive a confirmation/receipt via email or SMS.

2. Any missed classes, including same-day cancelations and 'no-shows', will not be individually refunded.

3. Please note: if you go into labor or cannot complete the session/s due to medical reasons, remaining classes can be credited towards the price of future private or group classes eg. an individual Postpartum Yoga Sessions (from 2-9 weeks after delivery), group Postnatal Yoga (from 8 weeks to 9 months), or regular yoga classes. The prices and schedule vary, advance booking is required.

4. All classes expire from six months form your purchase, unless prior arrangement is made with the instructor.
I, the undersigned, accept the terms and conditions as listed above. I understand that all exercise programs put stress on the body and may carry a risk of injury. I understand it is my responsibility to consult with my doctor/midwife before participating in this yoga class. I understand that I am not obliged to participate in any activity which I feel may be injurious, and will raise any concerns I have regarding the suitability of specific exercises or movements. I will seek professional medical advice relating to any health or injury issues, pre-existing and ongoing. Devika Coles will not be held responsible for injuries or health issues which may arise during the prenatal yoga sessions.
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