Nura Yoga Appointment Request Form
Book a unique Cultural and Yoga Experience!
Full Name
*
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact - (In case of emergency who should we contact?)
*
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What Nura Yoga program are you participating in
Yoga Walks on Country
Yoga on Country
Mental Health Aware Yoga
Please indicate any of the following that relate to you (give details where appropriate).
*
Tendency to breathlessness or asthma
Blood Pressure – High / Low
Muscle / Joint / Tendon problems
Diabetes
Recent Surgery (past 2 years)
Illnesses or Chronic Conditions
Anxiety/ depression/mental health concerns
Other
I have no medical conditions
If you selected "other" please list details here
What are your main reasons for joining this yoga class? (Select are that are relevant)
*
Stress management
Mental Health
Exercise & physical fitness
Increase vitality & energy
Participate in group activity/connect to others
Specific health condition or injury
Increase mind-body awareness
Reduce symptoms of trauma
Learning specific techniques ie mindfulness, meditation
Learning, engaging and connecting to First Nations culture and practices
Other
Do you have a goal or aim for doing yoga?
Would you like to be notified about any upcoming events or yoga sessions?
Yes
No
Acknowledgement and Liability Waiver
I acknowledge that yoga is not intended to replace medical care, and that it is my responsibility to advise the teacher of any injuries or health conditions that I may have. I acknowledge that it is my responsibility to do the yoga practices within my own limits and capacities, to prevent any injury.
Nura Yoga staff will seek emergency medical treatment if required at the participant's expense. If the participant is not responsive, the emergency contact person listed above will be notified
The Nura Yoga experience and sessions may be documented through imagery, videography, and/or audio. As a participant in the Nura Yoga program and session, I consent to Nura Yoga to record and publish my image/voice on Nura Yoga social media platforms, website, marketing and/or media materials. I understand that there will be no financial or other remuneration for either the initial or subsequent use of these images/photos/videos.
I acknowledge and respect the cultural learnings, practices and experiences Nura Yoga shares. I understand that through cultural protocols and Indigenous Cultural Intellectual Property that I may not take my teachings and capitalize, monetize, clone and/or reproduce any cultural learnings, knowledge or practices as a non Gadigal custodian or Traditional Owner.
I am aware that participation in Nura Yoga sessions and programs carries inherent risks, and injuries can occur. On rare occassions these injuries can be serious. I assume the risk of all injury and agree not to sue Nura Yoga, the staff, cultural knowledge holders, Directors or Elders for any injury caused by or resulting from participating in Nura Yoga sessions or programs.
I acknowledge that my Nura Yoga session program and/experience is not complete until full payment is recieved via the "bookings page" on the Nura Yoga website.
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