JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Toni Marie Yoga - New Client Info Form
Please provide information to assist me in meeting your needs for yoga classes and understanding any medical or special considerations I need to make. Thank you so much xxx
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Address
*
Your answer
Postcode
*
Your answer
Contact Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Emergency Contact Name
*
Your answer
Emergency Contact Relationship
*
Your answer
Emergency Contact Telephone Number
*
Your answer
Please provide details of any Medical Conditions and allergies
*
Your answer
Please provide details of any Injuries
*
Your answer
Please provide details of any regular medication
*
Your answer
If attending Bump and me classes please provide details of due date and any complications or considerations needed for class.
Your answer
If attending Baby and me classes please provide details of baby's name, date of birth and any considerations needed for class.
Your answer
Are you pregnant or have been pregnant in the last 3 months? If yes please provide details, including term, any complications etc
Your answer
Please provide details of anything else that may affect your ability to participate in class?
*
Your answer
What are your specific goals for participating in a regular class? Please give as much detail as possible for private classes.
*
Your answer
Do you agree to photographs being taken in class that will be used to promote Toni Marie Yoga classes on social media?
*
Yes
No
By taking part in Toni Marie Yoga classes, you take responsibility to ensure you move and practice safely. All your data is collected, stored and used in compliance with GDPR regulations.
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
