Yoga with Libby Rose: Registration Form
Thank you for joining in with Yoga Asana Classes.
Please fill out the form below as best as you can, you can always do another later if circumstances change.
It's wonderful for me to know you a little better so we can share this yoga (asana) practice.
Namaste x
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LOCATION OF CLASS *
Full Name: *
Email address:
Address & or Centre / location attending. 
Mobile / Telephone Number: *
Date of Birth: *
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Emergency Contact & Phone Number: *
HEALTH INFORMATION: *
Please Tick and explain more where applicable
Required
Do you have a medically diagnosed condition under the care of a GP or Specialist? *
If so, has your doctor provided clearance for you to participate in this program? *
Any additional information that you may wish to share for my attention:  (I will always respect your privacy)
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