Registration form for Yoga Sessions for persons with blindness and low vision

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Please fill all the details in the below form for us to understand you and your requirements well. Basis these details we will talk to you to do an assessment and be able to confirm the type of session suitable for you.

Email *

First Name *

Last name *

Country of residence *

State/ province *

City/ town *

Mobile Phone number (prefixed with country code) *

Age *

Height (in centimeters) *

Body weight (in kilograms) *

Gender *

Female

Male

Transgender

Don't wish to disclose

Occupation *

Describe your occupation *

Educational Qualification *

Disability *

Blindness/ low vision

Deaf/ hard of hearing/ speech impairement

Physical disability

Other:

Required

Please give some details about your disability (for e.g. extent of impairment) *

Medical reason causing the disability *

Other health/medical conditions (Please write in detail) *

Your expectations from our Yoga sessions *

Languages you can comfortably speak and understand *

Type of yoga session preferred
(Fees mentioned is only for people living in India) *

Details of any previous experience of Yoga *

Any other comments *

Please give a broad time bracket when you are available for the yoga session of one hour. *

Submit

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