Mums & Bubs - New Student Form

Mums & Bubs - New Student Form

Please fill in this form only if you have purchased the Mums & Bubs -5 Week term.
You and your babies name
How old is your baby?
Residential Address
Mobile Number

Area CodePhone Number
Email
example@example.com
What date was your baby born?

MonthDayYear
Date
Have you had your 6 week, postnatal check up? Have you been given the all clear to start exercising again by your health care professional?
How did you find out about Mama Soul Yoga?
Emergency Contact (Name & Phone Number):
Health History - Do you have any of the following conditions? c-section birth (within the last 6 months), Illnesses, Allergies, Injuries, heart condition, high blood pressure, low blood pressure, sciatica, blood disorder, diabetes, pelvic instability, varicose veins, Anxiety, Depression, Other?
I hereby certify that the above information is true and complete. I acknowledge that I am responsible for my health and safety while taking classes with Mama Soul and under the instruction of qualified teachers. I will take responsibility for not exceeding my limits and will report any injury or discomfort to the teacher. I agree to relay any information given to me from my health professionals relating to my health and provide Mama Soul with medical clearance where needed or requested. I hereby waive any claim that I might have in relation to any injury resulting from my participation in Mama Soul classes, workshops or events regardless of the cause. I have carefully read the above waiver, understand the content and agree to comply.
Date

MonthDayYear
Date
Signature

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