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Waiver and Disclaimer
Health Declaration
Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.
First Name
Last Name
Email
Age Group:
16 and under
17-34
35-44
45-64
65+
Have you practiced Yoga before? Yes / No. If Yes, please let us know more about your practice and style below.
What is your main reason for wanting to do Yoga?
What aspects of Yoga most interest you?
Physical Postures (Asana)
Breathwork / Pranayama
Meditation
Relaxation
Other
I agree the information herewith provide is to the full and best of my ability.
Do any of these health conditions apply to you? please tick
Abdominal Disorders
Back pain/problems
High Blood Preassure
Low Blood Preassure (fainting or dizziness)
Nerve damage / trauma pain
Shoulder / Neck problems
Knee Problems
Broken Bones / Stiffness / Swelling
Joint injury / Joint pains
Arthritis
Diabetes
Sensory Disorders affecting balance and coordination(Epilepsy, Eye Conditions, Vertigo, Ears)
Heart Condition
Respiratory problems (Asthma)
Depression / Anxiety / Mental Health
Pregnancy or pre or post natal
None
If you ticked any of the above or unble to find your concerns or conditions listed above, please provide further information below if you think this may affect your mobility or cause you concern when doing Yoga?
I agree the information herewith provide is to the full and best of my ability.
Date
Full Name
Submit
Thanks for submitting!
