Summer of Yoga

Summer of Yoga at Lympstone Manor

With Janet Kipling –Yoga Alliance Teacher
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

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INJURED OR UNWELL

Please consult your doctor before embarking on a new exercise programme if you have been injured or unwell. The classes are not a substitute for medical treatment and if you have any doubts as to the suitability of the exercise you must consult your doctor beforehand.

PREGNANCY

It is inadvisable to commence any exercise programme in the first trimester of pregnancy or within the first eight weeks following birth.

THERE ARE INHERENT RISKS

In doing any physical exercise such as yoga and, to the extent permitted by law, I accept no liability for loss, injury or damage incurred, sustained or made worse during, or as a result of, participation in my class.

TELL ME

Before each class if your ability to exercise, or your answers to the questions below, have changed please inform me.
Have you done yoga before?

YesNoA long time ago
How long for?
What type?
What other activities or sports do you do?*
Has your doctor ever said you have any sort of heart trouble or heart defect?*
Are you pregnant*

YesNoNot applicable
When is the baby due?
Have you had a baby in the last 12 months and if so when?
Have you had any operations or injuries in the past year?*
Do you suffer from arthritis, back, neck or knee pain or any other pain conditionor physical complaint?*
Do you have high/low blood pressure?*
Have you been advised not to exercise by any doctor or other medical practitioner?*
Do you have any other medical conditions, including mental health conditions, operations, injuries, medications or other issues? *
Sign Form

By signing below you: accept the inherent risks involved in physical exercise such as yoga; 2. confirm that you have disclosed any heath problems to me and discussed them with your doctor before commencing yoga; and 3.agree that I will not be, to the extent permitted by law, liable for any loss, injury or damage incurred, sustained or made worse during, or as a result of participation in my class.
Signature*

Clear
Today's date*

MonthDayYear
Your answers will be kept in line with Limitation Act 1980 and in keeping with GRPR requirements. All sensitve and personal information will be stored securely and for the purposes of ensuring your safety and well being in accordance with the participation of this class.

Should you like to know more information on our privacy policies please contact us on info@lympstonemanor.co.uk
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Summer of Yoga at Lympstone Manor

Sign Form