REGISTRATION & HEALTH STATEMENT

REGISTRATION & HEALTH STATEMENT

Life Balance Yoga
Full Name

First NameLast Name
Best Contact Number
Mobile preferred
Email
Confirm Email
example@example.com
Address

Street Address

Street Address Line 2

TownCounty

Post Code
Emergency Contact Person
Name (relation to you)
Their Emergency Contact Number

Area CodePhone Number
Date of Birth

MonthDayYear
Sex
Tick here to confirm that you agree to have your details stored electronically ?
Tick here to confirm that you want to be informed via email about holidays/cancellations/changes to classes.
These general classes are suitable for fit and healthy adults

Please understand that yoga is a physical activity which may result in injury. By completing this form, you undertake to participate in classes at your own risk. If you have any musculoskeletal problems, any of the health issues listed below, or any other health problem, please email details to the teacher before booking.
Please tick if you are currently or have you ever suffered from...?

Other
If TICKED, Details...
If you have ticked any of the above boxes or have any condition not listed, please give details here
Have you had surgery in the last two years?
If YES, Details...
Do you suffer from back pain?
If YES, Details...
Do you have any injuries?
If YES, Details...
Do you take any...?
If YES, please list...
Have you ever suffered from any of the following?

How would you rate your current physical fitness?

	1	2	3	4	5	6	7	8	9	10

1 is Poor, 10 is Athlete

How would you describe your nutritional habits?

Other
How did you hear about Life Balance Yoga?
I heard about these classes from:

Other
Please Read The Following T&C's.
By ticking the box below, I confirm that:

Cancellations

I understand that any cancellation needs to be made at least 72 hours in advance of a class and that if I cancel a class less than 72 hours in advance, I will be charged in full for that class.

Health

I have read and agree to comply with, the Coronavirus regulations that will be operational during my attendance at these classes.

I understand that yoga practice involves strong physical actions and I accept that such practice carries the risk of injury. I confirm that I have consulted my doctor about the advisability of participating in these classes where there are any doubts about my health.

All the information I have given on this form is correct to the best of my knowledge and that I agree to these terms and conditions.
I AGREE to the above terms and conditions.
LBY Number
After you submit this form, I will email you regarding your health statement and class suitability, along with your LBY number which you will need for booking classes.

To prevent this email and other future Life Balance Yoga emails from ending up in your junk or spam folder, please add my email address (leonorebunyard@gmail.com) to your address book.
Should be Empty:

Please Read The Following T&C's.