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Registration:- Surya Kriya: Jan 8-10th, 2022
Please fill in the information below.
This information will allow me to ensure that you can make the most of the program. All personal information will remain strictly confidential.
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Email
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Your email
First name
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Your answer
Last Name
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Your answer
Date of Birth
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Gender
Female
Male
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Address
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Your answer
Phone Number
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Your answer
Email Id
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Your answer
Women Only: Are you currently pregnant?
Yes
No
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Emergency Contact Name
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Your answer
Occupation
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Emergency Contact Number
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Your answer
Prior Experience of Yoga
Please give details of the types of yoga you have practiced and how long you have been practicing - if more than one, please include each below.
What is your prior yoga experience? E.g. None, beginners, etc.
Your answer
What type of yoga or meditation have you practiced? Please list e.g. Vinyasa, Ashtanga, Vipassana etc.
Your answer
Have you participated in any Isha Yoga Programs?
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Yes
No
If yes, please give details below (Program and Year)
Your answer
What do you hope to achieve from this program?
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Your answer
Have you attended any program with Sathya Yoga & Wellness previously?
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Yoga Asanas Workshop
Angamardhana Workshop
Angamardhana Drop-in Classes
Guided Meditation
None
How did you hear about the program?
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Facebook
Through friend/family member
Isha website/blog
Flyer/Poster
Email Ad
Other:
Medical Condition
Please take a minute to provide me with a few details of your current health condition.
Please indicate if you currently suffer from, or have previously suffered from any of the following condition/s?
*
Diabetes or Hypoglycemia
Heart conditions
High or low blood pressure
Stroke
Asthma or other respiratory conditions
Heartburn, peptic ulcer or intestinal conditions
Arthritis
Osteoporosis
Seizures/Epilepsy
Anemia
Endocrine conditions
Urinary conditions
Glaucoma
Hernia
Serious illness in the last three years
Injury in the last three years
Surgery in the last three years
Physical limitations or disabilities
Chronic pain
Psychotherapy, psychological therapy or counseling in the last five years
None
Other:
If you have checked any of the above, please give details of the nature and duration of the condition and if you are currently undergoing any treatment
Your answer
Have you been administered with the Covid vaccine in the last 2-3 months?
Yes
No
Clear selection
Allergy History: Please indicate if you currently have or have previously experienced any of the following allergies
Food allergy
Drug allergy
Chemical allergy
Environmental allergy
None
Other:
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If you have checked any of the above, please give details of the nature of the allergy and the treatment required in case of emergency
Your answer
Thank you for registering. We look forward to seeing you at the workshop :) In the meantime, if you have any questions, do not hesitate to get in touch: 0775821550/
sathyayogawellness@gmail.com
A copy of your responses will be emailed to the address you provided.
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