Yoga Registration Form

Welcome to Breathe Yoga Classes!

Please enable JavaScript in your browser to complete this form.

Layout

Full Name

Phone Number

Layout

Email Address

Address

Layout

Emergency Contact Name

Emergency Contact Number

Layout

Do you have any breathing conditions?

Do you have any spinal conditions or injuries or any back or neck pain?

Do you have any other conditions?

Have you had any operations in the last two years?

Are there any movements or positions that are painful?

For female students only: are you pregnant or trying to concieve?

Please list any medications that you are taking:

Please list below anything else that may be helpful for your teacher to be aware of:

Have you practiced yoga before?

We would love to know what has drawn you to this yoga class and what you wish to receive from attending, if you feel to share:

How did you learn about Breathe Yoga Classes?

Which Breathe Yoga class are you booking in for (online or in-person & day of week)?

Acknowledgement

Breathe Yoga Classes are very gentle and safety is considered in all aspects of teaching, however, if you have any concerns regarding your health conditions, you agree to consult your doctor prior to attending. It is essential that you hold full responsibility for your own physical and general well-being in applying instructions in this guided program to your own circumstances. The golden rule is ‘if it doesn’t feel right then don’t do it’. Take care of yourself and reap the benefits. Practice deepening your awareness and understanding of your body, your breath and your self.

I understand that by attending yoga classes that I am fully responsible for my health and wellness.

Signature (just do your best!)

Clear Signature

Date of Signature