Student Consent Form

Student Consent Form
Student's Name

PrefixFirst NameLast Name
Email
example@example.com
Contact number
Address

Street Address

Street Address Line 2

Town/City

Postcode
Date of Birth

DayMonthYear
Date
Gender

MaleFemaleOther
If below 18 years old (minor), please enter name of parent or guardian

First NameLast Name
Parent/Guardian's Contact Number
Have you done yoga or any other form of fitness exercise?

YesNo
If yes, can you please provide more details?
Do you have any physical disability or any health issues/conditions that we should be aware of?

YesNo
If yes, please provide more details.
Do you have any of the following?

Lower Back painUpper Back painShoulder painNumbness to any part of the bodyMuscular painNeck injurySeizuresKnee surgeriesAllergiesSurgery
Are you pregnant? (For female)

YesNo
In case of an emergency concerning you at the studio, who do we contact?

First NameLast Name
Relationship to you
Emergency Person Contact Number
Emergency Person Email Address
Consent Agreement
I, First NameLast Name of legal age would like to participate in a yoga class being offered by Cameo Studio. I fully understand that yoga is a physical activity that may or may not cause physical injury. I agree to declare any health issue, conditions I may have before signing up for the classes. I fully recognise that any injuries sustained from the physical activities will be my responsibility. Therefore I release Cameo Studio of any liabilities. I have read and fully understand the terms of the agreement/waiver and accept all of it.
Client Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

Student Consent Form

Consent Agreement