Class Enrolment Form

 

Yoga Class Enrolment Form

 

 

Personal Details

 

Name: …………………………………………………………………………………………...

Address: ………………………………………………………………………………………...

…………………………………………………………………………………………………….

Telephone No. ………………………………………………………………………………….

Emergency Contact No. ……………………………………………………………………….

Email Address: …………………………………………………………………………………

 

Any Past Yoga Experience: Yes/No

Any yoga aspirations:

 

 

 

Physical Fitness Level: Please give a brief description of any physical activities currently undertaken, such swimming, jogging, etc.

 

 

Medical Matters: Please tick any that apply

 

  • High/Low Blood Pressure  
  • Asthma
  • Eye problems
  • Arthritis/Joint problems
  • Heart Condition
  • Carpal Tunnel Syndrome
  • Back/Neck injury or problems
  • Plantar fasciitus
  • Pregnant or recently had baby
  • Varicose veins
  • Recent surgery 
  • Shoulder injury
  • Hernia
  • Epilepsy

Please briefly describe any other medical concerns relevant to your yoga practice

 

 

 

 

Signature:

 

Date: