TCTSY Trauma Sensitive Yoga Class Enrolment Form

TCTSY Course Enrolment Form

Trauma Sensitive 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 NameLast Name
Email for newsletter and communication*
example@example.com
Phone Number*
Please enter a valid phone number.
NDIS or concession card no.
Follow social media?

FacebookInstagramLinked In
Have you been referred by your GP or mental health specialist?*
Do you have support from an ongoing therapist?*
If yes, please include their name and contact no. We would like to be in contact with them before the course.
Do I have permission to contact your therapist?*

YesNo
Have you been hospitalized for psychiatric care in the last 6 months?*
Do you have any specific health goals or reasons for enrolling?*
Medical information: Do you have any of the following now or in the past?*

PTSDClinical depressionAnxiety disorderComplex or developmental traumaAutoimmune disordersAsthma or breathing difficultiesAre you pregnant or planningHeart stroke conditionRegular headachesBack painLow blood pressureHigh Blood pressureDiabetesEpilepsyDizzinessCancerArthritisother
Are you currently engaged in any physical activity?*
Do you meditate or have you practiced any relaxation techniques?*
Have you undergone any recent surgery? Have you been hospitalized recently?*
Are there any issues you wish to share about triggers with yoga poses/breathing/lighting etc, that you have had in the past that you wish to share?*
If you are having a rough day, who do you turn to for support?*
Are you currently taking medication on a regular basis?*
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
Which TCTSY class are you joining

Wed 12.30pm
Date signed*

MonthDayYear
Date
Sliding scale fees that include GST. Please choose which fees feel appropriate or you.
Please transfer payment to;

Kendra Boone BSB: 313 140 Account: 124 280 98

Please note your name and preferred class on the payment description.

Make sure you submit this form, click the orange 'submit' button at the bottom of the form.
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, you will reap the health benefits yoga can bring.

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

What is expected

Attend the full 8-week program

Attend each class free from the influence of drugs and alcohol

Manage strong enotions that might arise - they are welcome

See your therapist once during the course

Bring a personal blanket or towel

Class Fees

If you are challenged to pay the full fee please email Kendra at restore@kendrahealingarts.com.

There are 2 ways to make the term payment.

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

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

Missed Class Policy

I highly encourage full attendance and your commitment to getting the most out of your practice. Missed classes can not be caught up in the next term.

Early Cancellation

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

Class Cancellations

Occasionally classes need to be cancelled on short notice. Classes will be extended to the following week.

Thank you
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TCTSY Course Enrolment Form