Mamazen Health Questionnaire 13/02/2023

Estimated Due Date

Date

No.of weeks pregnant

Are you pregnant with twins or multiples?

Is this your first pregnancy?

During this pregnancy are you currently experiencing any of the following symptoms?

Have you practised yoga before? If so which style?

What aspects of pregnancy yoga interests you?

Do you give permission for photos to be taken of you and used in social media/advertising/website?

Do you give permission to be added to a WhatsApp group?

Legal Notice

Although all reasonable attempts have been made to ensure the information provided is accurate, Mamazen does not assume responsibility for errors or ommissions. Reliance on any advice offered by Mamazen is soley at your own risk.

Refund Policy

Refunds are not possible once this form is submitted.

Medical Disclaimer

By ticking this, I am declaring that I have disclosed to my yoga teacher all information regarding my health relevant to the practice of yoga during my pregnancy. I take full responsibility for all applications of yoga I practice in the class and outside the class during my pregnancy. I fully understand that the recommendations, ideas or techniques expressed and described in the pregnancy yoga classes cannot be regarded as a substitute for the advice of a qualified medical practitioner. Any uses to which the recommendations, ideas and techniques are put are at my sole discretion and risk.

My Products

Pregnancy Yoga Classes

13th February (4 week block) 7.30pm

£40.00

Total

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I have read and agree to the terms and conditions

MamaZen - Pregnancy Yoga Class Health Questionnaire

Terms and Conditions

My Products

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