Jo Lovell Yoga Registration

Jo Lovell Yoga Registration
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 conditionsNone
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. running
Yoga Class Details
Select the class(es) you are interested in*

Monday 10:30 Beginners - Kirklands Community Centre, MenstonMonday 19:30 Beginners - Kirklands Community Centre, MenstonTuesday 19:30 General - Zoom ClassWednesday 19:30 Beginners - Kirklands Community Centre, MenstonThursday 19:30 General Class - Queens Hall, Burley in WharfedalePrivate lessons (times to be arranged)RetreatsWorkshops
Marketing
How did you find out about Jo Lovell Yoga?*

Word of mouthInternet searchFacebook/TwitterPoster/flyerOther
Like/Follow Me
Payment

Payment is required at the time of booking. Please note that bookings are taken on a first come first served basis. Payment is required 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 informaiton is treated in the strictest confidence.

Thank you for completing this form.

Cancellation Policy: Please give 5 days notice if you are unable to attend a full term of classes/workshop/event booking to receive a 100% refund. If less notice is given it is difficult to re-allocate the space to another student. If you cancel with less notice the full cost will be due.

By submitting this form you are agreeing to my terms and conditions. Please read these carefully.
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I agree to the terms and conditions
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Jo Lovell Yoga Registration

Personal Details

Health & Wellbeing Information

Yoga Information

Yoga Class Details

Marketing

Payment