Yoga and Meditation Student Registration Form

I care about you. The information you provide here enables me to understand your health, any illness or injuries and your yoga/meditation experience, so that I can give you my best meet your needs.  

Fill in the form as fully as possible. You can write as much as you need to for the open-ended questions, as the boxes expand to fit the amount of text. When selecting your Date of Birth, please select the ‘year’ first.

Name(Required)
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Address(Required)
Date of Birth(Required)
Have you recently undergone surgery (within the last year)?(Required)
Do you have any ongoing medical conditions?(Required)
e.g. high/low blood pressure, diabetes, anorexia, epilepsy, depression, anxiety etc
Do you have any current or recurring physical injuries?(Required)
Are you pregnant or post-natal?(Required)
Whilst in poses/postures, you may be touched or physically adjusted by the teacher. This is a normal part of yoga/meditation practice. Do you consent to this?(Required)
Have you practised yoga or meditation before?(Required)
Do you wish to subscribe to our newsletter?(Required)
We provide a monthly email newsletter, filled with tips, special offers and our upcoming events. You can unsubscribe at any time.
Acceptance of Terms & Conditions(Required)
This field is for validation purposes and should be left unchanged.