Information Forms

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Yoga with Cat Information Form Online

Required fields are marked *
Name *
Contact Number *
Email Address *
Emergency Contact Information *
Please add contact Name, Contact Number and Relationship to yourself.
Have you attended a Yoga class before? *
Yes
No
If yes, what style and length/level of practice *
Do you participate in any other form of exercise? *
If yes, please give details.
The following information is given to ensure your safety when taking part in our classes. Yoga can be practiced safely by pretty much anyone but some complaints/conditions require special attention.
You MUST consult your doctor if you have any doubts/concerns before starting classes.
Please answer the following questions to help us decide how best to help you practice in class. Give details as needed.
Do you have a medical condition for which you take medication? *
Yes
No
Please give details below.
Do you have a medical condition that does not require medication? *
Yes
No
Please give details below.
Are/could you be pregnant or have you given birth in the last 6 weeks? *
Yes
No
Please give details below.
Have you had surgery or any medical procedure in the last two years? *
Yes
No
Please give details below.
Have you ever received treatment from a Physiotherapist, Osteopath, Chiropracter? *
Yes
No
Please give details below.
Please give details for the above medical information questions here.
During face to face classes -
Hands on adjustment is sometimes needed/helpful. Do you agree to be touched? *
Yes
No
During Savasana, Relaxation or Yoga Nidra we use Lavender Eye Bags. Are you okay with Lavender? *
Yes
No
For Online Face to Face classes or Online Recorded classes -
Modifications & Individual Requirements cannot always be given. *
Yes
No
Please indicate that you understand and accept the limitations of online practice.
Declaration I confirm that the information given on this form is correct. I understand it is my responsibility to
* Check with my doctor if I have any difficulties or concerns about my ability to practice yoga.
* Advise the yoga teacher of any changes to my medical information.
* Follow the advice given by my doctor and/or yoga teacher
I also understand that I cannot hold the yoga teacher or any facility owner responsible for any injury I may suffer.
I take part in the yoga classes offered at my own risk.
Signature *
By adding your name you accept all information is correct and agree to the declarations above.
Date *
All information given will be treated in the strictest confidence and will be stored in accordance with current Data Protection guidelines.
By completing this form you agree to your contact details being retained and used to send you information about future classes, events or information you may find useful.
We use email, social media messaging and/or text messages.
No info required here, please press the button below.