Please specify how we may contact you (phone, email, or text).
How did you hear about Kibwe Eshe Yoga? Have you practice yoga before? Please Select Yes No, my first time Yes, but not consistently If yes, for how long?
Emergency contact name and number Please check any existing or past conditions. Check all that apply. Asthma 2 Hip pain or discomfort 1 Neck/should pain 2 Back pain/soreness 2 Knee pain 1 Anxiety or depression 1 Pregnant 1 Joint pain or injury 1 Heart/circulatory problems 2 Seizures 1 Dizzy spells 2 High or low blood pressure 2 Please list any current limitations or injuries.
Please list any other health concerns, allergies, or medical conditions that could cause concern during yoga session.
Please read and initial each agreement. If at any time during class, you feel discomfort or strain, gently come out of the posture. You may rest at anytime during class. It is important in yoga to listen to your body, and respect its limitations on any given day. Initial* I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. Initial* I understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including yoga. I recognize that it is my responsibility to notify my teacher of any serious illness (including Covid-19) or injury prior to every yoga class. I will not perform any postures to the extent of strain or pain. Initial* I accept that neither Kibwe Eshe Yoga (KEY), the instructor, nor hosting facility are liable for any injury, or damages, to person or property, resulting from taking KEY yoga class. Those under 18 years of age must have this form signed by a parent or guardian.Initial *