Student Information Form

Student Information Form

Please complete and submit before your first class.
Name*

First NameLast Name
Email*
Please provide your contact email address.
Mobile Phone Number*
Please enter a valid mobile phone number.Format: 0000-0000000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Describe any physical issues or medical conditions you want to make me aware of*
Say none if nothing to tell me.
Describe any medication you need to carry and may have on you in the studio (eg inhaler or EpiPen)*
Say none if nothing to tell me.
BeginnerSome practice, but not regular or recentCurrent regular practice
Not pregnantCurrently less than 14 weeks pregnantCurrently more than 14 weeks pregnantGiven birth less than 6 months ago
Please note I do not normally accept new students who are pregnant or less than 6 months after giving birth. If either applies to you, please provide details in the Anything Else? field below.
Anything Else to tell me?*
Is there anything else you want to tell me? Say none, if there’s nothing.
IMPORTANT - please read

All forms of exercise (including Yoga) carry the risk of injury. You should listen to your body and not push yourself beyond what feels right for you.

If you are not sure whether you are able to practice Yoga, you must consult your doctor and follow their advice.

Please tell me if you become pregnant and wish to continue attending classes. Students less than 14 weeks pregnant must not attend class.

The information you provide me, helps me teach you. It is treated as confidential and securely stored. My insurers require me to keep this information for 7 years from the date of your last class with me.

If anything changes or you need to tell me something new please email me at sally@sallyjaneyoga.uk
Date Form Completed*

MonthDayYear
Please confirm date of signature
Signature*
Should be Empty: