Intake Form (Group Classes)

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Full Name *

E-mail *

City/ Town, Country *

What are your intentions and needs for practice?

Are you experiencing any injuries, conditions, or circumstances that you would like Kimberley to be aware of? If yes, feel free to describe.

How did you hear about Kimberley's services? *

I understand that yoga practices may serve as complementary wellness tools and not substitutes for professional medical care.

I am responsible for my personal safety during class, adapting Kimberley's guidance to honour my unique needs and intentions.

I am aware that I might experience sleepiness during class. I will ensure sufficient alertness if I must operate a vehicle or do anything else that requires full attentiveness after class. Likewise, I will set an alarm if I must wake up at a specific time after class.

I accept that classes are non-refundable. If I am unable to attend a class, I may request a recording within 1 week of the class.

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All information on this form will be kept confidential.

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