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

Classes you wish to attend*

Monday Evening Yoga for Men & WomenTuesday Morning Yoga for WomenTuesday Evening Somatic Movement & Authentic Embodied Dance for Men & WomenWednesday Morning Somatic Movement & Authentic Embodied Dance for Women
Registration Form for Yoga and Somatic Movement & Authentic Embodied 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*
PLEASE DO NOT TYPE COUNTRY CODE IF YOU HAVE UK NUMBER !
Birth Date*

DayMonthYear
Age*
Gender*
Age Categories (Westminster Council categories)*

18-3031-50Over 50Over 70
Address*

Street Address

Ward

CityBorough

Post Code
Ethnicity: *
Ethnicity Categories (Please note these are Westminster Council categories)*

AfricanCaribbeanAnyother Black/African/Caribbean backgroundArabBangladeshiChineseIndianPakistaniAnyother Asian backgroundWhiteIrishGypsy or Irish TravellerAny other WhitebackgroundWhite and AsianWhite and Black AfricanWhite and Black CaribbeanAnyother Mixed/Multiple ethnic backgroundOtherUnknownPrefer not to answer
Religion Categories (Please not these are Westminster Council categories)*

BuddhistChristianHinduJewishMuslimSikhNo religionUnknownPrefer not to answer
Do you consider yourself to have disability or learning difficulty?*

YesNo
Any health issues teacher should know about? *
If you have attended our classes before, which ones did you attend?

Monday Evening Yoga for Men & WomenTuesday Morning Yoga for WomenWednesday Morning Dance for Women
How would you rate the class(es) you have attended with us in the past?

ExcellentVery goodGoodAveragePoor
Where did you hear about us? *
Where did you hear about us:*

FacebookInstagramWeb / Google searchWhatsApp groupFlyer from school/nurseryFound a flyer in the communityPoster on a noticeboardWord of mouthCoffee morning at a school/nurseryAn event / networking eventOther
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*

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

Mala CHERGA Theatre classes are funded by