'Yoga By The Bay' Participant Questionnaire

Name

First NameSurname

DOB

Address

Mobile

Format: (000) 000-0000.

Email address

Emergency Contact Name

Emergency Contact Telephone

Format: (000) 000-0000.

Do you have any injuries/ chronic illness/ physical limitations (including joint problems, bad knees/ back/ shoulder/ wrists/ neck), asthma, diabetes? If yes, please give details

Are you taking any medications on a regular basis. If so, what is it for and does it restrict your ability to exercise?

Are you doing any exercise currently. If so which form of exercise?

Have you tried yoga before?

What would you like to gain from the 'Yoga By The Bay' yoga classes?

Are you okay for Katy to add you to her 'Yoga By The Bay' WhatsApp group so you can receive important updates (i.e. if wet weather plan is being put in place)?

Where did you hear about Yoga By The Bay?

THANK YOU for completing the questionnaire. Now, please SIGN and DATE the consent below.

I understand that Katy Bennett is a qualified, professional yoga teacher and will ensure that all due care is taken when teaching me. However, by attending Katy's 'Yoga By The Bay' class(es), | accept that participation in any yoga exercises could constitute a risk of serious injury to myself. I acknowledge that Katy Bennett shall not be deemed responsible for any injury, illness or other mishap I may sustain arising from, or out of, or in any way directly or indirectly connected with the yoga and fitness exercises ran by Katy Bennett at 'Yoga By The Bay'. If previously injured, I am aware that I should have checked with a Doctor to determine if I am safe/ suitable to exercise.

Signed

Dated

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