Yoga Registration Form

Yoga 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 Information

Select all you are interest in
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 19:30-20:30Wednesday 18:50-20:05Thursday 19:30-20:45 - Queens Hall, Burley in WharfedaleFriday 9:00-10:00Friday 19:00- 20:00 (Monthly Restorative & Pranayama Class)
Select any other yoga related activities you are interested*

Personalised Yoga - 121 sessionsYoga Therapy (support a health condition or injury) - 121 sessionsWeekend Yoga RetreatsYoga WorkshopsAyurveda (Nutrition and Lifestyle) ConsultationsNot sureNone at the moment
Communication
How did you originally find out about Jo Lovell Yoga?*

Word of mouthInternet searchFacebookInstagramPoster/flyerOther
Keeping in touch to receive updates about Yoga & Ayurveda events and news. Please add me to:

The newsletterWhatsApp class community group (this is the most effective way to stay informed)Not at the moment
Please take a minute to like or follow my socials, this makes a big difference. Thank you so much!
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, 2025
I understand that I am undertaking this class, workshop or retreat at my risk and I accept that Jo Lovell will accept no responsibility for any injury suffered.
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.
I agree to the terms and conditions
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Yoga Registration Form

Personal Details

Health & Wellbeing Information

Yoga Information

Yoga Information

Communication

Payment