Planted Wellbeing Health Form
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Your Details
Your Full Name *
Your Address *
Your Email Address *
Mobile Telephone Number *
Date of Birth *
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Emergency Contact Details
(please ensure you have this person's permission before sharing information)
Emergency contact name *
Emergency Contact Telephone Number *
Your Yoga/Exercise Experience and Goals
Have you practised yoga before? *
If yes, what type, frequency, how recently?
Do you take part in other sports/physical activity? *
If yes, what type?
What are your yoga goals? *
Required
Your Health Information
It is important that when attending class that you keep me informed of any changes to your health such as injury, pregnancy or other conditions you feel may affect your ability to practice yoga
Do you have any medical condition, injuries or challenges I should be aware of? Please provide details. *
Have you had any surgery or been pregnant in the last 6 months? *
If yes, please provide details
Consent and Other Information
I consent to being contacted by planted wellbeing with information about classes/events. *
Required
Where did you hear about Planted Wellbeing? *
Terms and Conditions
I have no medical condition or injury that will prevent me from participating in yoga. It is my responsibility to inform the yoga teacher of any changes to my health. I understand that yoga involves a risk of injury and I confirm that I am voluntarily participating in this activity with the knowledge of the potential dangers involved. I will act with due care to safeguard my own safety and that of fellow students. I will listen to my body and will not push myself beyond my limits. Adrienne Hanson/Planted Wellbeing does not attempt to exclude liability for any loss, personal injury or death caused as a result of her own negligence. Please ask for GDPR/Data privacy policy or see our website. I have read the agreement and fully understand the contents.
I have read, understand and agree to the terms and conditions. *
Required
If under 16, form must be signed by parent
Parent's name
I agree to my under 16 taking part
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