Earthed Yoga Class Health Form 2024
The following information is treated as confidential. Please indicate if you experience any of the conditions mentioned and provide details that may affect your ability to do yoga.  Classes can be tailored to your needs.
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Name *
Telephone number *
Email address *
How did you find out about the class? *
Have you practiced yoga before? *
I give consent to my yoga teacher to hold and use my contact details above for the purpose of informing me of future yoga classes and yoga related events via a newsletter.  Please note that you can opt out of these communications using the unsubscribe button or by informing your yoga teacher. *
I give consent to my yoga teacher to use any testimonials or quotes that I may give about my experience of the classes I attend. *
What are you hoping to gain from yoga classes?
About my health
My general health is... *
I experience or have experienced (tick all that apply)
I am taking the following medication
Are you or could you be pregnant? *
Please use the space below if you want to say more about yourself
Disclaimer. I confirm I am over 18 years of age and I take full responsibility for my own health and wellbeing during the class and when I practise anything taught in an Earthed Yoga class (add your name to confirm) *
Date of completion *
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To fulfil legal and insurance obligations, this data will be stored securely in a password protected file for 7 years from your last class.
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