Registration Form

Registration Form
Personal Details
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Mobile phone number*
Email*
example@example.com
Emergency contact details*
Emergency contact number*
Age*

18-2526-3536-4546-5556-6566+
Gender

MaleFemale
Health & Wellbeing Information

Complete this section as fully as possible
Tick relevant medical conditions

Cancer or benign tumoursDetached retinaEpilepsy including Petit MalHeart diseaseHypertension (high blood pressure)Immune system disorderMEMeniere’s diseaseMultiple Sclerosis (MS)Post operative conditionsNoneOther
Details of any previous medical conditions
Details of current medication
Details of any mental health issues
Areas of physical concern
e.g. areas of stiffness or aches and pains
Current exercise routine
What current exercise do you do regularly?
Yoga Information
Have you done yoga before?
If yes, what style of yoga have you practised?
If yes, for how long?
What are you looking to get out of doing yoga? Tick as many options as relevant*

General fitnessImprove a health issue e.g. bad backImproved flexibilityImproved strengthImprove wellbeingRelaxation and mindfulnessReduce stress levelsSpiritualityStretching the body to complement another activity e.g. runningOther
Yoga Class Details
Select the class(es) you are interested in, unless otherwise specified the class is held at Kirklands Community Centre Menston*

Monday 10:30-11:30Monday 19:00-20:00Monday 20:00-21:00Wednesday 19:0-20:00Thursday 19:30-20:30 - Queens Hall, Burley in WharfedaleFriday 9:00-10:00Friday 19:00:20:00 & 20:00-21:00 Restorative (Monthly)Personalised lessons (times to be arranged)Yoga Therapy SessionRetreatsWorkshopsOther
Marketing
How did you find out about Jo Lovell Yoga?*

Word of mouthInternet searchFacebook/InstagramPoster/flyerOther
Communication
Newsletter - add me to the newsletter? To keep you up to date with yoga & Ayurveda related news.

YesNo
WhatsApp - add me to the WhatsApp group? (it is the easiest way of letting you know about the class and used to quickly communicate information to you.

YesNo
Please Like/Follow Me (This makes a big difference to me so please take a minute. Thank you!)
Payment

Full payment must be made at the time of booking your place. Please be aware that bookings are confirmed on a first come, first served basis. Payment is necessary to secure your booking.
Bank Transfer

Bank: Starling

Account Name: Joanne Lovell

Sort Code: 60-83-71

Acct No: 14830772

Reference: (Day AM/PM, Term, Year) e.g. Mon AM, Term 1, 2023
Your personal information is treated with the utmost confidentiality.

Thank you for filling out this form.

By submitting this form, you are consenting to agree to my terms and conditions. Please review them carefully.
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Registration Form

Personal Details

Health & Wellbeing Information

Yoga Information

Yoga Class Details

Marketing

Communication

Payment