Tribal Soul
Registration Form
Client Details:
Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone number
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Date of birth
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Month
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Day
Year
Date
E-mail
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example@example.com
Occupation
Have you done yoga/Pilates before, if so how long ago and what style ?
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Any physical ailments that might hinder practice
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Have you consulted a doctor for approval to practice
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Please tick if any of the below apply
Have you ever been diagnosed with a heart condition and can only do physical activity when recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by change in your physical activity?
Is your doctor currently prescribing you drugs (for example water pills) for your blood pressure or heart?
Do you know any other reasons why you should not do physical activity?
Please provide details below including how this may affect your participation during any sessions.. State any other medical conditions .
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How did you hear about us?
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Please Select
Facebook
Instagram
Website
Other (Please specify...)
Next of Kin
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Name
Telephone Number
Payments and Cancellation Policy. Payment must be made prior to session. Tribal Soul will not be able to offer any refunds. Transfers for cancellations will will not be accepted either within 24 hours of your booked session. If Tribal Soul cancels you will be offered a full refund, or a transfer to another date. Monthly bookings are only valid that particular month and sessions cannot be transferred into a new month.
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yes I agree
Further Information. If you have high or low blood pressure or have detached retina please make sure to talk to me before class. Please inform me if you are pregnant and classes are undertaken at your own risk. In providing your email address and a ticking the opt-in box you are electing to subscribe to Tribal Soul newsletter email list, this is simply used to keep you informed. We will never share, rent or sell your personal information to third parties and you can unsubscribe at anytime.
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yes I agree
Bank details
Name: Sarah-Anne Capewell
Account number: 46330420
Sort code: 04-00-03
Name
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First Name
Last Name
Date
*
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Month
-
Day
Year
Disclaimer -Agreement of Release and Waiver of Liability. I understand and acknowledge the fact that in Yoga/Pilates, as in other forms of exercise, there are certain inherent risks. I voluntarily participate in the retreat, yoga, Pilates classes and other programs offered by Tribal Soul, and agree to assume full responsibility for all risks, injuries or damages, known or unknown, which I might incur as a result of participating in said programs offered by Tribal Soul. I understand that it is my responsibility to consult with my health care professional in regard to my participation in the retreat, yoga. Pilates classes or other programs offered by Tribal Soul. I release Tribal Soul, its owners as well as any person working as instructors, teachers, mentors or volunteers from all liability and hold them harmless for any injury to me or my person and for any damage or loss to my property incurred whether caused in or out of class, by negligence or otherwise. Missed classes will not be refunded or transferred.
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