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Please complete this form prior to attending class, it is to ensure we are fully aware of any medical conditions or injuries.

Health Declaration

Please fill out the following form before attending class ( this only has to be completed once)

First Name

Email

Have you done yoga before? *

Yes

No

Have you been hospitalized in the last 12 months? *

No

Yes

Last Name

Date of Birth

Are you expecting and in the first trimester *

Yes

No

NA

Are you suffering from a medical condition, illness, or injury? *

No

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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