Yoga New Client Form

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Please submit BEFORE your first yoga class.
Please note, all the information on this form is kept strictly confidential.

Email *

Full Name *

Date of birth *

YYYY

Gender *

Female

Male

Prefer not to say

Emergency contact name and number *

Have you attended a yoga class before? *

Yes

If yes, how long have you practiced yoga?

If yes, what style of yoga have you practiced? (if known)

What is/are your main reason(s) for wanting to practice yoga? *

Improve flexibility

Get stronger

Heal mind, body & soul connection

Weight loss

Release trauma stored in body

Stress release

Have fun

Other:

Required

How did you hear about us? *

Do you participate in any other physical activity? *

Gym training

Jogging

Swimming

Tennis

Badminton

Martial arts

Hiking

Walking

Cycling

Aerobics

Other:

Required

How regularly do you participate in the above activities? *

Daily

Once every two days

Sometimes

Rarely

Other:

Health and Medical Information

The following information is required to ensure your safety. Whilst yoga may be practised safely by the majority of people, there are certain conditions which require special attention. If you are unsure, please consult your GP before commencing class.

Please tick the boxes below if you have any of the following medical conditions. These conditions require specific modifications to your yoga practice.

Abdominal disorder or recent surgery

Arthritis (osteo or rheumatoid)

Back pain (if known cause please state below)

Knee problems

Hip problems

Shoulder problems

Neck problems

Heart disorders

High blood pressure

Low blood pressure

Other:

Please tick the boxes below if you have any of the following medical conditions. These conditions may affect your practice and thus provide useful information for your instructor.

Asthma

Diabetes Type 1 or 2

Auto-immune disorder (e.g. ME, MS, Lupus etc.)

Epilepsy

Anxiety/Depression

Sensory disorder affecting ears or eyes

Balance-affecting disorder

Other:

If you ticked any of the boxes above for the last two questions. Please give more details below.

Are you / could you be, pregnant, or have you given birth in the last six weeks? *

Yes

Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by yoga practice? *

Yes

If yes, please give more details.

Have you had any recent operations (in the last two years)? *

Yes

If yes, please state what the operation was.

If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in yoga that you listen to your body and respect its limits on any given day.

TERMS AND CONDITIONS

PAYMENT TERMS

All yoga packages must be paid for in advance of any sessions taking place.

Payments must be made by bank transfer or cash.

All sessions must be completed within 3 months.

The contracted time period begins on the date on which the first paid session of the pack takes place.

CANCELLATIONS

If you need to cancel a session that you have booked, you must give the Instructor 24 hours cancellation notice. Instructors pay rent in the location they are training you in. The 24 hours notice is required so they may fill your session slot with another client. Failure to give 24 hours notice will result in you being charged the full session rate. The only exception to this cancellation policy is unforeseen illnesses.

If for any reason, your instructor has the need to cancel your appointment within 24 hours, your next session will be provided free of charge.

If a session needs to be rescheduled, an attempt will be made to arrange at a mutually convenient time for you and your Instructor within the given time period. Sessions cannot be ‘carried over’ beyond the 3-month mark.

REFUNDS

If you are unable to continue your sessions due to medical reasons, a refund may be available for any remaining sessions. You will need to provide your Instructor with evidence (i.e. a letter from your doctor) explaining that you are unable to continue due to medical reasons, including a time frame of this restriction prior to a refund being given.

Refunds cannot be provided under any other circumstances.

In the unlikely event of your Instructor being unable to continue sessions, you are eligible for a full refund on outstanding sessions.

LATE ARRIVALS

If your Instructor is more than 15 minutes late for your session, you will receive one hour of free yoga, arranged at a mutually convenient time for you and your Instructor.

If you are late for your session, your session length may be reduced accordingly, and you will be charged at the normal session rate.

If you are more than 20 minutes late, the session may be cancelled, and you will be charged for the full session at the normal session rate.

INSTRUCTORS

Should you experience any pain, discomfort, or injury during any of your sessions, please inform your Instructor, so that they can assure appropriate action is taken.

There are inherent risks in participating in a programme of strenuous exercise.

Should you sustain a claim to any injury while participating in the session programme, you acknowledge that your Instructor is not responsible, except where the injury was caused by the gross negligence or intentional act of the Instructor.

Prior to, or during the course of your yoga programme, health concerns may arise that may require further input from your Doctor, Physiotherapist, or other allied health care professional. If such concerns arise, you should consult an appropriate health care professional before continuing your sessions.

Please be aware that your Instructors are not health care professionals and cannot diagnose and/or prescribe treatment for any form of injury, disease, or other medical problem.

Any nutritional guidance and/or meal plans provided are to be taken as recommendations and are not prescribed diets.

You understand that your answers to the questions outlined in the Health and Medical Information portion are true and complete to the best of your knowledge.

You understand and agree that it is your responsibility to inform your Instructor of the conditions or changes in your health, now and on-going, which may affect your ability to exercise safely and with minimal risk of injury.

DECLARATION

I, the undersigned, confirm that the above information is correct and understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I will not perform any postures to the extent of strain or pain.

I confirm that I am not aware of any medical condition that would affect my ability to participate in Yoga sessions safely.

If there are medical conditions that I have made my Instructor aware of, I confirm that I have been given permission from my Doctor or Physician to fully participate in Yoga sessions.

I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class. I understand that it is my responsibility to:

• Check with my doctor if I have any difficulties or concerns about my ability to participate in the yoga classes.
• Advise the yoga instructor of any change in my medical information.
• Follow the advice given by my doctor.

By printing your full name below and ticking the box you are submitting your electronic signature.

Full Name *

Date *

YYYY

Signature (Ticking the box below will be recorded as your signature) *

I agree

Required

Send me a copy of my responses.

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