Yoga Class Enrolment Form

YOGA Course Enrolment Form

Mindfulness Yoga with Kendra
For a matter of both safety and courtesy, please answer the following pre-screening questions. The information obtained will be treated as confidential and will not be revealed to any person other than Kendra.
Name *

First Name Last Name
Email for newsletter and communication *
example@example.com
Phone Number *
Please enter a valid phone number.
Follow social media?

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Do you have any specific health goals or reasons for enrolling? *
Are you currently engaged in any physical activity? *
Do you meditate or have you practiced any relaxation techniques? *
Medical information: Do you have any of the following now or in the past? *

High Blood pressure Low blood pressure Heart stroke condition Diabetes Epilepsy Arthritis Asthma or breathing difficulties Back pain Regular headaches Autoimmune disorders Are you pregnant or planning Clinical depression Anxiety disorder PTSD Cancer Dizziness other
Have you undergone any recent surgery? Have you been hospitalized recently? *
Have you been hospitalized for psychiatric care in the last 6 months? *
Do you have support from an ongoing therapist?
If yes, please include detail. We would never contact your therapist unless there is a clinical emergency. Is that ok with you?
Are there any issues you wish to share about triggers with yoga poses/breathing/lighting etc, that you have had in the past?
Are you currently taking medication on a regular basis? *
Have you been referred by your GP or mental health specialist? *
In my opinion there is no medical reason why I should not take part in the online or face to faceYoga Class. I understand that all safety precautions will be observed but Iagree to accept responsibility for any injuries that may be sustained whilst taking part in these classes. *

Clear
Date signed *

Month Day Year
Date
Investment

To secure your booking please make your payment to:

Kendra Boone BSB: 923100 Account: 31620858 or pay by credit card below.

Please note your name on the payment description.

Make sure you submit this form, click the green 'submit' button at the bottom of the form.

Which class/es do you wish to join? Enrolment fees are sliding scale as we value accessibility. You are invited to reflect on your access to resources. *

Monday 9.30am 7-week term

$ 175.00 AUD Quantity Sliding scale payment system
Item subtotal: $ 0.00 AUD

Tuesday 6pm 10-week course

$ 250.00 AUD Quantity Sliding scale payment option

Friday 9.30am 10 week term

$ 250.00 AUD Quantity Sliding sclae payment option

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Class selection *

Monday 9.30 am - 10.45 am, Health Point, Phillip Tuesday 6 pm - 7.30 pm, Health Point, Phillip Friday 9.30am - 10.45am - Canberra Yoga Space, Phillip
Terms and Conditions

My policies have been developed over the last 15 years and aim to give you flexibility in payment and encourage commitment to regular attendance.

As lessons are planned each week and considered a progressive program, it is important to commit your time in advance. This way, your yoga practice will flourish, and you will reap the health benefits yoga can bring.

Classes generally follow a school term and are approximately 8 to 10 weeks long.

Please carefully read the following policies. Your understanding is appreciated.

Class Fees

The class pass fee guarantees you a yoga mat space each week and shows your commitment for those weeks. A sliding scale of payment is offered so please consider your access to resources, and be a supporter where you can, so all may access the classes.

There are 2 ways to make the term payment. By bank transfer or credit card.

If you know you will not be able to attend a class in advance, then please email Kendra requesting a reduced term rate prior to term commencing.

Transfers

If you know you are unable to attend a class that has been prepaid, then you have the option of transferring to another class for that week. This is subject to availability.

Term fees cannot be transferred onto the following term if classes are missed.

Term enrolment may be transferred on to another person.

Missed Class Policy

I highly encourage full attendance and your commitment to get the most out of your practice. Missed classes must be paid for if paying weekly. There are now 3 classes to choose from on the timetable which allows for flexibility.

If you miss a class during your term, you are welcome to make it up at another class during the same term.

Early Cancellation

Refunds will not be issued if requesting early cancellation but can be transferred to another class time.

Class Cancellations

Occasionally classes need to be canceled on short notice. All effort will be made to provide a make up class after the term.

Om shanti
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YOGA Course Enrolment Form