Where did you hear about classes at The Yoga Room?
Do you have any injuries: e.g. knee reconstruction, stiff neck or back, or ANY other injuries or problem areas?
Are you taking any medication? What for?
Do you, or have you had, any serious medical conditions: e.g. high or low blood pressure, diabetes, cancer or any other health problems? Please list below.
Answer if applicable - are you pregnant? If yes, how many weeks?
Have you done any yoga in the past? If yes, when and where?
What are you hoping Yoga can offer you?
Who is your next of kin?
Please provide their contact phone number:
If you are enrolling a child or children please list their names and ages below:
Do you consent to your/your child's photo being taken in class occasionally for promotion?
The Yoga Room does not offer remedial yoga. Information students provide on this form about health conditions is helpful to teachers to modify poses to suit circumstances of individual students. Part of our philosophy is to teach students to practice yoga being responsible and mindful of their own health conditions. All information given is confidential.
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