Yoga Essence - Registration Form
Please note all information is kept strictly confidential
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Email *
Full Name: *
Address:
Phone Number: *
I agree to receive updates about classes and workshops by email: *
Required
I agree to be contacted by email or phone (text or WhatsApp) in the event of a class cancellation: *
Required
Emergency Contact Name:
Emergency Contact Phone Number: *
Have you practiced Yoga before *
If yes, how long have you been practicing Yoga?
How did you hear about us?
We would really appreciate your feedback here but it's entirely optional!
7 (b) Other - please let us know how you heard about us?
Please list any medical issues or injuries? *
Do you have any numbness or pain in (please select) *
Are you pregnant?  Please note these yoga classes are NOT suitable during pregnancy.  We recommend tailored pregnancy yoga classes. *
DECLARATION / WAIVER: I should consult a physician prior to enrolling to practise yoga. Otherwise I assume the risk of my own physical condition.  I understand that yoga or meditation is not a substitute for medical attention, examination, diagnosis, or treatment.  

I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class.   I will not perform any postures or practices to the extent of strain or pain.  I will always stay in a pain free zone. If at any time during the class, I feel discomfort or strain, I will gently come out of the posture.  

I accept that neither the teachers, nor Yoga Essence are liable for any injury, or damages, to person or property, resulting from taking the class or in the future and I use the premises at my own risk.
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Your Name: *
Signed: *
Date: *
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