Yoga and Somatic Movement & Authentic Embodied Dance for Adults Registration Form

Classes you wish to attend
Registration Form for Free Yoga and Phoenix - Somatic Dance for Adults

Fill out the form carefully for registration
Student's Full Name
Type your 1st name followed by middle name followed by surname
Student Name

First NameMiddle NameLast Name
Student E-mail

Confirmation Emailexample@example.com
Mobile Number

Country codePhone Number
Birth Date

DayMonthYear
Age
Gender
Age Categories (Westminster Council categories)
Address

Street Address

Ward

CityBorough

Post Code
Ethnicity:
Ethnicity Categories (Please note these are Westminster Council categories)
Religion Categories (Please not these are Westminster Council categories)
Do you consider yourself to have disability or learning difficulty?
Any health issues teacher should know about?
If you have attended our classes before, which ones did you attend?
How would you rate the class(es) you have attended with us in the past?
Where did you hear about us?
Where did you hear about us:

Other
Additional Comments
I knowingly, voluntarily and expressly waive any claim I may have against Mala CHERGA Theatre for injury or damages that I may sustain as a result of participating in Yoga classes by Mala CHERGA Theatre.
Signature
IMPORTANT

When you submit your registartion form you will receive an emial from 'Jotform' with your registartion form and a word document in the attachement entitled 'IMPORTANT INFORMATION AND ZOOM LINKS'. Please read this document carefully and save the zoom links for online classes.

We look forward to seeing you,

Mala CHERGA team
Mala CHERGA Theatre classes are funded by
Should be Empty:

Registration Form for Free Yoga and Phoenix - Somatic Dance for Adults

Mala CHERGA Theatre classes are funded by