Online Yoga Class Registration Form

Online Yoga Class Registration Form

Find Your Balance, Inside and Out
Name

First NameLast Name
Email
example@example.com
Phone Number
Are you pregnant?

YesNoTrying to conceive
Due date?

MonthDayYear
Date
Schedule Preference (All Times in MST)

Monday Morning Session - 10:00AM to 11:00AMMonday Afternoon Session - 1:30PM to 2:30PMMonday Evening Private Session - 5:30PM to 6:30PMWednesday Morning Session - 10:00AM to 11:00AMWednesday Afternoon Session - 1:30PM to 2:30PMWednesday Evening Private Session - 5:30PM to 6:30PMFriday Morning Session - 10:00AM to 11:00AMFriday Labor w/ Love - 12:00PM to 1:00PMSoul Sunday Session - 1:30PM to 2:30PMOther
If other, please specify
Have you taken a yoga class before?

YesNo
Goals for taking yoga classes?
Down Doula Daijah will contact you for private session scheduling

Thank you!
I (your full name) blanks consent to being on camera, have pictures taken, or being recorded during these sessions. Pictures/recordings will only be used for grant/certification purposes.
Please sign below
Signature

Clear
Should be Empty:

Down Doula Daijah will contact you for private session scheduling