Health Checklist Form - Yoga Events with Geny Caloisi

Health Checklist Form

Please complete the following health checklist form prior to your Yoga meeting with Geny Caloisi, from CheYoga and Ayurveda Wellness.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of birth

MonthDayYear
DoB
Have you experienced any of the following symptoms in the past 14 days? (Select all that apply)

FeverCoughShortness of BreathSore ThroatLoss of Taste or SmellFatigueHeadacheMuscle or Body AchesNasal CongestionNausea or VomitingDiarrheaOther
Do you have any of the following:

High or low blood pressureInjured joint or extremityInjured spineHerniaHigh Blood pressureHeadaches/MigrainesEye problemsArthritisEpilepsyHeart ConditionAre you on Medication?Are you pregnant?
Please give any further details, include allergies, food or other.
Participants must meet health and fitness requirements to join the Retreat.

They should be physically and mentally healthy, demonstrating mental and emotional stability, maturity, and a positive attitude.

It's recommended that a physician be consulted to ensure suitability for the workshop or retreat.

The Instructor is inclusive and doesn't discriminate based on various factors. However, they reserve the right to ask any participant to leave if they disrupt the harmony of the Retreat.
Emergency contact, name and number
Have you done Yoga before? Please provide any additional comments or information.
YOGA WORKSHOP/RETREAT AGREEMENT AND RELEASE OF LIABILITY

By signing below, you agree to be legally bound by this agreement and release of liability. This is a binding legal contract between you, Geny Caloisi, the lead instructor and leader of the retreat, and her limited liability company, Che Yoga and Ayurveda Wellness.
Your personal details will be kept confidential and used only for workshop-related communication.If you would like to receive updates about future events, classes, or offers from Geny Caloisi / CheYoga and Ayurveda Wellness, please tick the box below.

Yes, keep me informed
Signature

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Find out more about Geny Caloisi on:

Instagram: https://www.instagram.com/geny_caloisi/
Podcast:https://podcasters.spotify.com/pod/show/geny-caloisi
Youtube:https://www.youtube.com/c/CheYogaGenyCaloisi
Fb: https://www.facebook.com/cheyoga.london

Website: www.cheyoga.co.uk
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