PRIVATE CLASS REGISTRATION

Please fill out this registration form with as much information as possible to maximise the benefits of your private classes.

Name

First Name

Last Name

Age

Occupation

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Number

Country

(###)

###

####

Email Address

Yoga experience

Years practicing, types of yoga, regularity, homes practice:

Medical history

Any medical conditions that may impact your practice:

Injury history

Any injuries, historical injuries, or physical limitations that may impact your practice:

Objectives for your private classes

What do you hope to achieve from your private classes:

Release of waiver & liability

I understand that any activity, including yoga, involves a risk of injury and that I am voluntarily participating in these activities with full knowledge and appreciation of the dangers involved. I understand that if a private class is canceled less than 24hrs in advance the cost of the class will be my responsibility. I declare all of the information provided by me to be correct to my knowledge and have not withheld any information, medical or otherwise, that may result in any consequences.

Yes