Yoga Registration

New Student Registration Form

We appreciate your time is important and to make the best use of it we ask that you complete this online form. It will only take a couple of minutes and will ensure we have a detailed understanding of your strengths and experience to date.

Name*

Date of Birth*

Gender*

Male
Female

Phone*

Email*

Emergency Contact

Emergency Contact*

(Name)

Emergency Contact No.*

General Questions

Have you practiced yoga before?

Which style of yoga did you/ do you practice?

What do you enjoy most about this practice?

Do you have any injuries or limitations that we need to be aware of?

Are You Pregnant?

Yes
No

On a scale of 1 – 10, in each of the following areas, what areas of your life would you like to make the most impact on through your personal yoga practice?

Physical

Please enter a number from 0 to 10.

Mental

Please enter a number from 0 to 10.

Emotional

Please enter a number from 0 to 10.

Please read carefully before submitting*

I understand that yoga includes physical movements, kriyas, breath practices, meditation and relaxation. I am fully aware of the risk of injury and acknowledge that I am practicing yoga, meditation and wellness activities at my own risk.

If I experience any pain or discomfort, I will listen my body, rest as necessary or adjust the posture, and ask support from the Teacher. I will not perform any postures to extent of strain or pain. I accept that neither the instructor, nor the hosting facility, are liable for any injury, or damages, to person or property, resulting from the taking of the class.

I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any yoga class. I will advise the teacher if I am pregnant or have a medical condition. It is my own responsibility to decide to practice yoga if pregnant. I represent and warrant that I am physically fit and am able to fully participate in any yoga class today or in the future.

I understand & Agree