Your name

Address

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Emergency Contact Number

Health Conditions

I do not wish to declare medical informationBack or neck problemsBlood pressure problemsBreathing issuesDetached retina/other eye problemsDepressionHeart problemsJoint ProblemsKnee problemsNeck problemsRecent fractures/sprainsRecent operationsRecent pregnancies or currently pregnant

I confirm the above information is correct.
I understand that it is my responsibility to:
- check with my doctor if I have any difficulties or concerns about my ability to participate in the yoga class
- take full responsibility for my health during the yoga class
- ensure that my surroundings are clear and safe for the practice of yoga
- advise the yoga teacher of any change in my medical information 
- follow the advice given by my doctor and/or yoga teacher.

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