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Birth Doula
Yoga
Pregnancy Yoga
Mums & Bubs Yoga
Yoga Retreat Day
Yoga Therapy & Private Yoga
Massage
Thai Yoga Massage
Pregnancy Massage
Thai Foot Reflexology
Hens Parties and Girls Weekends
Gift Vouchers
Training
Thai Yoga Massage Level 1
Thai Yoga Massage Level 2
Advanced Thai Yoga Massage Techniques
Thai Yoga Massage for Pregnancy
Pregnancy Yoga Teacher Training
Couples Thai Massage Training
Thai Yoga Massage Taster Workshop
Thai Foot Reflexology Training
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Yoga Registrations
First name
Last name
Email
Phone number
Address
Occupation
Date of birth
MEDICAL HISTORY
Have you had any major surgery? If so what & when?
Please give details of any injuries, fractures, dislocations and how long ago.
Do you have any of the following?
High or low blood pressure
Heart problems
Asthma
Arthritis
Carpal Tunnel
Neck problems
Back problems
Other (please specify below)
Other
Are you pregnant or planning to be?
Yes
No
If you answered 'yes' in the previous question, when is your due date?
Do you have any further information including special medical/physical considerations that we should be aware of? (Please provide details)
YOGA EXPERIENCE
Have you practiced yoga before? If so, for how long and where / what kind?
What is it you would like to get out of yoga?
Relaxation
Stress Management
Flexibility
Strength
Relief from back or neck pain
Other (please specify below)
Other:
INFORMED CONSENT
I have been informed, understand and am aware that strength and flexibility exercises including yoga are potentially hazardous activities. I have also been informed, understand and am aware that these activities involve a risk of injury. I am voluntarily participating in these activities and using equipment with full knowledge, understanding and appreciation of the dangers involved.
AGREEMENT
I understand that the instructions given throughout classes are intended only as a guidance. It is therefore my responsibility to adjust my practice according to my limitation to ensure no personal injury occurs; and inform the teacher before the class of any recent change to my physical condition.
I hereby declare that by submitting this form I release Dani Mondahl of any responsibility for any injury sustained and that I will take full responsibility for myself during the yoga classes.
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