YOUR BODY,
YOUR PRACTICE

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone

(###)

###

####

Do you have any existing medical conditions or injuries?

Tick all that apply

Low blood pressure

High blood pressure

Respiratory conditions

Heart conditions

Diabetes

Anxiety

Other

None

Waiver: *

I acknowledge that participation in yoga classes involves physical activity and carries some inherent risks.

Yes

Waiver: *

I am responsible for monitoring my own well-being during class and will speak to the teacher about any concerns.

Yes