Melé Yoga New Student Registration Form v6

To be completed by yoga, sound healing or reiki session participants for in-person and online teaching.  All information given will be treated in the strictest confidence and stored in accordance with Data Protection Legislation.

Ideally, please complete this form online here.  Or if you would prefer to print, complete and email a copy the links you need are below.scroll to the bottom of the form and you will find the download link and email address.
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If you are attending a remote (online zoom class) you may wish to download The British Wheel of Yoga's Student Guidance notes (applies to sound healing and reiki too).  The link is below. 

Email your form to: mel@meleyoga.com

Remote Online guidance notes: www.meleyoga.com/links - BWY Student Guidance Remote Sessions

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Email *
First Name *
Last Name *
Birthday - DD MM YY
(You can type it in - Ignore invalid date message until you've finished typing the full format - DD MM YY)
 *
MM
/
DD
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YYYY
House Number / Name *
Street *
Address Cont. *
Town/City *
County *
Post Code *
Country *
Email (Primary) *
Email (Other)
Mobile Phone *
Phone (Home/Other)
Emergency Contact Name *
Emergency Contact Number *
Have you attended a yoga, sound healing or reiki session before? *
If yes, how long have you practiced/attended?
If yes, what style have you practiced? (if known)
How did you hear about this class? *
Can I contact you about new term dates and class updates (like what kit to bring to class) and other updates?   If yes, please select how below:
 *
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Required
Do you participate in any other physical activity, e.g. gym work, jogging, swimming, aerobics, badminton, cycling, walking or other? *
How regularly do you do this?
These conditions require specific modifications to your session. If yes, please give details:
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Further information (Modifications to practise):
These conditions may affect your practise and so provide useful information for your teacher:
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Further information (Affect practise):
Are you / could you be pregnant, or have you given birth in the last six weeks? *
Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by the session?  If yes, please provide details: *
If yes, please provide details:
Have you had any recent operations (in the last two years)? *
If yes, please advise what the operation was:
Please tick this box if you do not wish to declare medical information
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DECLARATION AND WAIVER - I agree to the following information *
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Signed  - Please type your Full Name to sign *
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Date Signed *
MM
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DD
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YYYY
Signature of Parent/Guardian if student is under 18 years - Please type your Full Name to sign
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Parent/Guardian Date Signed
MM
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DD
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YYYY
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