Questionnaire for Yoga

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All the information given will be treated wth the strictness confidence.

Leave out any questions you would prefer not to answer, bearing in mind that the answers given will help to insure that the class is suitable and appropriates for you to attend.

Email *

Name *

Date of first class: *

YYYY

Address *

Home Telephone number *

Mobiles Telephone number *

Age: *

Please say which is your preferred method of contact in case of cancellations *

Please provide the details of someone we can contact in case of an emergency. *

How did you come to hear about Emilie Garrould / Wild Yoga Norfolk? *

Google

Instagram / Facebook

Poster/ Flyer

Website

Magazine

Word of Mouth

Other:

Required

Have you practiced yoga before? *

Yes

If so, please specify for how many years and if you know the type of yoga.

Do you have any injuries or medical conditions? Please give as much detail as you can. (ie. High/Low blood Pressure/ Arthritis/ Recent Surgery) *

What are you hoping to gain from this class? *

Please highlight any particular areas of interest.. *

Breathing Aspect

Strengthening muscles & toning

Relieving various ailments

Quiet time for relaxation

Making friends

Meditation

Philosophy

Other:

Required

Client Declaration (Please read and check boxes to confirm) *

As far as I am aware, I have disclosed to my yoga teacher all information regarding my health relevant to the practice of yoga .

I take full responsibility for all applications of yoga I practice in the class and outside the class.

I fully understand that the recommendations, ideas or techniques expressed and described these yoga classes cannot be regarding as substitutes for the advice of a qualified medical practitioners.

If I experience any pain or discomfort in the practice, I will observe this and release from the pose or back away from my end range.

I understand that yoga is not safe under certain medical conditions, I will consult my GP if I am unsure.

Any uses to which the recommendations, ideas and techniques are put are at my sole discretion and risk.

If at any point I feel any symptoms of illness including; lack of taste, smell or coughing. I will not attend the class.

If I am contacted via track and trace I will notify my yoga teacher at the earliest convenience.

Whilst the yoga teacher will do their best to prevent the spread of COVID 19, I am aware of the potential risk by attending a class.

I hereby agree to irrevocably release and waive any claims that I have now or hereafter, with Wild Yoga Norfolk.

Required

Please sign your name to confirm you have read all of the above *

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