Yoga Disclaimer Form
Please provide your personal and medical information and confirm disclosure for participation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Event You Are Attending
*
Have you done yoga before?
*
Yes
No
If yes, how long have you practiced yoga?
Do you have any of the following medical conditions?
Arthritis
High blood pressure
Epilepsy
Asthma
Diabetes
Low blood pressure
Back pain
Heart conditions
Migraines
Do you have any other injuries or medical conditions?
Are you currently pregnant?
Yes
No
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
I confirm I have disclosed all medical information to the best of my knowledge.
*
I agree
Submit
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