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Sarah W Yoga, Sharnbrook

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Registration Form

Yoga in Sharnbrook, Riseley, Bedford

This registration form has been designed to help you to
help yourself.
Many benefits are associated with regular exercise and this form is designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them.

First Name

Last Name

Email

Emergency Contact

Name

Phone Number

Date

Initials

Have you done yoga or pilates before? * Required

Yes

No

I'm not sure

Other

If yes, how long for?

Why do you want to practice yoga/pilates?

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

Please tick which apply to you

Neck and Shoulder Tension

Backache

Headaches

Trouble sleeping

Stress / Anxiety

Depression

High Blood Pressure

Low Blood Pressure

Diabetes

Epilespy / Seizures

Glaucoma or Detached retina

Heart Conditions

Pregnant

Do you have a bone or joint problem (e.g. back, knee or hip), that could be made worse by a change in physical activity?

In the past month have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Has your doctor ever said that you have a heart condition and can only do physical activity recommended by a doctor?

Do you feel pain in your chest when you do physical activity?

Is your doctor currently prescribing drugs for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

I confirm that I am able to take part in yoga/pilates sessions. If I feel any discomfort or start feeling unwell during the class I shall inform the class teacher. I accept full responsibility for my own safety.

I want to subscribe to the newsletter. Please add me to your mailing list. I would like to be kept informed on classes and any other information on yoga/pilates events with Sarah. Sarah will never share, rent or sell your personal information to third parties and you can unsubscribe at anytime.

I understand my booking is non refundable. I can rearrange my yoga/pilates class booking within 8 hours of the class start time or no later than 48 hours before my Thai Yoga or Indian Head Massage appointment. For workshops/events I will check the specific terms and conditions at www.sarahwyoga.co.uk.

Thanks for submitting!

Yoga in Sharnbrook, Yoga with Sarah

Teen Yoga Sharnbrook

Yoga Alliance Profressionals, Sharnbrook, Bedford

Menopause Yoga Accredited Teacher

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Contact

07702 898 773

sarahwyoga79@gmail.com

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