Inner Blooming - Friday 17th June Student Registration Form
Fill out the form carefully for registration
Welcome and thank you in advance for completing this form.
Student Name
First Name
Middle Name
Last Name
Phone Number
-
Area Code
Phone Number
Gender
Male
Female
N/A
Student E-mail
How did you find out about this yoga event ?
Have you practised Yoga before ? If so which of these?
with a friend or teacher
on my own
with the help of books or recordings
taken courses
on retreat
Please can you write a little about your yoga experiences , which teachers, styles...
What interests you about joining this yoga event ?
Do you have any health issues , back pain or injury or other?
Do you have any past or present sleep or eating issues, health or mental health issues ?
Is there anything else you wish Julie to know ?
To register for this course please confirm below that you are over 18 years of age and fully responsible for your mental and physical health.
I agree and confirm
" I will not share course materials nor the sharing of other participants with anyone else. I commit to keeping all communications confidential"
I agree
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