Your Health & Goals

Please complete this form prior to attending your first class. It provides me with information to adjust classes to cater for your health requirements and to plan future classes.

A confirmation message will be displayed when the form is successfully submitted.

The completed form is treated as confidential.

If you prefer to complete a paper form, download and print the following file:
Student Health & Goals form

You will need a PDF reader like Adobe Acrobat Reader to read and print the form.

Fields marked with an asterisk (*) are required.

Your Contact Details
Provide your first (or preferred) name and family name.
Emergency Contact Details
Name of the person to contact in the case of an emergency.
Health Information
Have you ever had or do you have any of the following:
Are you or do you think you're pregnant?
If you are pregnant, which trimester are you in?
Are there any specific activities that you cannot physically do?
Please read the following carefully.
Confirm your understanding and agreement of the following: *
  • I have answered all questions to the best of my ability.
  • If requested, I will obtain medical clearance before starting my yoga classes.
    I understand that the teacher cannot give me medical advice on my fitness and the information given by me is used as a guideline to assess my ability to do the yoga activities.
  • I take full responsibility for myself during the classes and I agree to adjust my practice according to my limitations. The decision to perform any yoga practice is mine.
    I understand that instructions in class are intended as guidance and, that while all due care will be taken by the teacher, he or she cannot be responsible for my improper practice at any time.
  • I will notify my teacher before each class begins of any recent injury, illness, surgery or pregnancy.