Enrolment Form

Enrolment Form

Mamas & Minis- Pre/Post Natal Yoga
Term 4-

WEDNESDAYS (8 week block) $176

9.45am-10.30am (Little movers & beyond)

AND

10.45am-11.30am (Babies 6 wks to wrigglers)

16/10, 23/10, 30/10, 6/11, 13/11, 20/11, 27/11, 4/12

Either paid in full prior to week 1 or paid in 2 installments of $88 in Week 1 and $88 in Week 4.

Location-

Eltham North Hall

8 Cedar Avenue, Eltham North

Free parking & baby change facilities avalible on site. Park at the top carpark upon entry. Enter into the foyer through the large glass doors and walk towards the right hand side.

BYO YOGA MAT & BLANKET FOR YOUR BABY TO LIE ON. PRAMS, CAPSULES & BOUNCERS WELCOME. FOR OLDER CHILDREN SOME QUIET TOYS & A SNACK IS RECOMMENDED. OLDER CHILDREN MIGHT ALSO LIKE TO BYO YOGA MAT.
Your Name*

First NameLast Name
Phone Number*
Your E-mail*
example@example.com
Please select which class you wish to enrol in*

WEDNESDAYS 9.45am Mamas & Minis- Little movers & beyondWEDNESDAYS 10.45am Mamas & Minis- Babies 6 weeks to wrigglers
Child’s/children's names & ages attending with you*
If pregnant, how many weeks will you be when classes begin?
How many weeks/months/years post partum are you? We advise 6 weeks minimum post birth & a GP or health professional clearance to return to exercise or begin any new exercise if you are currently pregnant. Write N/A if you are currently pregnant*
Did you experience any pre/post birth or current pregnancy complications that may affect your yoga practice? If YES please specify below, if not write NO*
Do you experience any of the following?*

High or Low blood pressureHeart ProblemsAsthmaArthritisCarpal TunnelWeakened Wrists/kneesNeck ProblemsGeneral back painPubic Symphysis Pain and/or Sacroiliac painAbdominal SeparationPelvic floor weaknessNone of theseOther
If you selected 'other' or have more than one concern above please specify
Does your child/children have any medical conditions that may effect their ability to join in with baby yoga/baby massage? If YES please describe below, or if not write NO or if pregnant currently.*
Emergency contact name & phone number *
What do you hope to get out of the class?*

RelaxationFlexibility & strengthRelief from neck, upper body & back painPelvic floor strengtheningGentle Yoga and stretchingMore active fitness type yogaConnection and bonding with your miniMeeting other local Mamas & minisOther
If you selected 'other' or have more than one answer above please specify
Do you give permission for photographs/videos taken of you & your child to be used for promotional & marketing purposes for Little Lunar Yoga? Eg Instagram or our website.*

YesNo
How did you hear about us?*
Unfortunately classes are NOT eligible for refunds or individual make ups if you cannot make it along. If a class is cancelled by the teacher a MAKE UP CLASS for the group will be offered on an alternative date. If a make up class is unable to be scheduled for the group a REFUND will be provided.*

Yes I agree
How would you like to pay?

Full Payment $176- Due prior to Week 1 (8 week block)Partial Payment- 2 payments of $88. Due prior to Week 1 and in Week 4 (8 week block only)
Bank Details:

Name- Little Lunar Yoga

BSB-013333

A/C-1551 70936

REF-YOUR FULL NAME POST NATAL
I agree to adjust my practice according to my limitations to ensure no personal injury occurs. I agree to inform the teacher BEFORE class of any recent injury or change to my physical condition. I hereby declare that I release Little Lunar Yoga of any responsibility for any injury sustained and that I will take full responsibility for myself and my baby/child during the classes.*

Yes I agree
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