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Katrina Marie Yoga Intake Form
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Email
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Your email
What's your full name
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Your answer
Where are you from in this beautiful world?
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Your answer
How did you hear about us?
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Your answer
We love to celebrate! When is your birthday?
Your answer
Do you give consent for hands on adjustments? (There will always be ways for you to communicate discretely if you ever change your mind on this.)
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Yes
No
N/A Virtual only class
Do you give consent for the use of topical, properly diluted essential oils?
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Yes
No
Yes, but I have some allergies or oils I do not care for (you can tell us about them below)
N/A Virtual only class
Tell us about any injuries you have.
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Your answer
Tell us about any allergies you have.
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Your answer
If you are joining us for trapeze, be aware that the trapezes are weight tested for up to 400 pounds. For safety reasons we must honor this limit. Do you agree to join a trapeze class only if you are within the safe range for practice?
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Yes
I'm not within the safe range currently.
I don't plan to practice trapeze.
If you are joining us for trapeze and feel comfortable please tell us your height to make setting up and starting class more seamless and efficient.
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Your answer
Tell us about your practice, what brought you to yoga, and what you would like to gain from practicing with us.
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Your answer
Tell us about anything you are drawn to or curious about and would like to experience, learn, or work on. (Example: chakras, kundalini, astrology, meditation, etc.)
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Your answer
Let us know if there are any upcoming classes, workshops, masterclasses or trainings you would love to see on the schedule.
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Your answer
Do you want to join our email list?
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Yes, Please!
No, Thank you.
What's your best email?
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Your answer
Do we have permission to text you?
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Yes, Please!
No, Thank you.
What's your phone number?
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Your answer
Because we like to be extra safe, please type the name AND phone number of your emergency contact.
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Your answer
Please type your name below for consent for media release.
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Your answer
Our classes are a safe space for everyone, including our instructors. Please type your name below to acknowledge that you understand that we have the right to remove anyone (without refund) from any class (in person/virtual) at any time who is disruptive or makes anyone feel threatened or unsafe.
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Your answer
Please type your full name below to verify that you have read and accepted our terms and conditions.
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Your answer
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