BMSM YS Yoga Registration Form
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Full Name (Please write your family name in capital letter. eg: LEE Ah Beng) *
Zoom entry name (Zoom video must be switched on during the session) *
Address *
Email address *
Date of birth *
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Tel. (Mobile) *
NRIC No. *
Gender *
Contact (in case of emergency) Name *
Contact (in case of emergency) Relationship *
Contact (in case of emergency) Telephone *
This confidential information will help your instructor(s) become aware of your specific needs during the workshop / class.
Background
Current medical treatment  (if any) : *
Previous medical treatment (if any) *
Are you currently or within the last 1 year, under a physical’s care or undergone any medical operation?    (Yes / No) If yes, please specify : *
Do you experience pain in any part of your body – on occasion, acute or chronic? *
Please list any medical conditions, illness, broken bones, surgeries, or accidents that you believe may be helpful and any precautions that should be taken to ensure your well-being. *
For female, are you currently pregnant? (Yes / No). If yes, please state the number of weeks : *
Yoga Experience
What is your experience in Yoga practices? *
Have you had any previous Yoga injuries? (Yes / No)                                                                                                                         If yes, how did it happen? *
What is your main goal for Yoga practice? *
Terms and Conditions
I hereby agree to release the instructors from any liability due to my own negligence in the workshop / programme / class duration.  I understand that :                                                                                                                                                                                                                                           (a) All due care will be taken by the instructors and all practices need to be followed attentively.                                                                                     (b) I do not need to do the practices which are too difficult for me. I will do my best to follow the requirements of the workshop / programme/ class without any changes to my lifestyles.                                                                                                                                                  (c) I am encouraged to participate at my own pace and time, therefore I will not try to compete or strain myself physically, mentally or emotionally in workshop / programme / class.                                                                                                                                                (d) I declare that the information I had given is true to the best of my knowledge and I have not withheld any information concerning my health.                                                                                                                                                                                   (e) If any time there are changes in the information given or in my condition, I will update this form before the workshop / programme / class.
Declaration *
Required
Note: Bank details for payment to be provided after approval of registration
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