Enrolment Form

Enrolment Form

New Mamas & Minis Group
Term 2

WEDNESDAYS

10.30am-11.15am (Babies from 6 wks/ non movers)

30/4, 7/5, 14/5, 21/5, 28/5, 4/6, 11/6, 18/6, 25/6, 2/7

Sign up for 5 weeks (half term) or 10 weeks (full term)

x 5 weeks-$120 due on enrolment

x 10 weeks=$240 due on enrolment

Location-

Eltham North Hall

8 Cedar Avenue, Eltham North

Free parking & baby change facilities available 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.
Your Name*

First NameLast Name
Phone Number*
Your E-mail*
example@example.com
Babies names & ages attending with you*
How many weeks post partum are you? We advise 6 weeks minimum post birth and a GP or health professional clearance to return to exercise or begin any new exercise.*
Did you experience any post birth or 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.*
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 & minisLearning baby massage and yoga to use at homeOther
If you selected 'other' or have more than one answer above please specify
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
Please select your preferred enrolment option:*

Half Term (x5 weeks) $120Full Term (x10 weeks) $240
Please make payment via direct bank deposit

Bank Details:

Name- Little Lunar Yoga

BSB-013333

A/C-1551 70936

REF-YOUR FULL NAME NEW MAMAS
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
Should be Empty: