Yoga Contraindications

Health Form

Yoga Retreat
Title
Name

First NameLast Name
Gender
Date of birth

MonthDayYear
Date
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Emergency Contact

First NameLast Name
Emergency contact phone number

Area CodePhone Number
Any injuries or surgery in the last six months

Yes
If you any of these apply to you , please tick the box
These conditions may affect your practice and so it will be useful for your tutor to be aware of them:
Further information
Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by yoga practice?
Are you or could you be, pregnant, or have you given birth in the last six weeks?
Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other?
Do you have any allergies?

Other
Allergy details if any
Address of doctors surgery

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please read this information about yoga benefits and risks

Please read this information about Cacao benefits and risks

Please read this information about spa benefits and risks
I have read the information about yoga benefits and risks.
I have read the information about Cacao benefits and risks.
I have read the information about spa benefits and risks.
GDPR Statement
In order to comply with the General Data Protection Regulations, it is necessary for me to check whether or not you are happy for me to retain your contact details, and to send you information that I think may be useful to you, including training and events, and relevant updates. I only hold information when it is necessary to do so in order for me to carry out my work, and when you have given me permission to do so. To ensure that I only communicate with you in the manner of your preferred choice, please will you indicate below, your agreement, or otherwise, to the following means of communication:
Contact perferences
Please verify that you are human
Should be Empty:

Health Form

GDPR Statement