Your Child's Health

Please complete this form prior to your child attending his or her first class. It provides me with information to adjust classes to cater for his or her 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:
Child's Health 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 Child's Details
Provide your child's first (or preferred) name and family name.
Emergency Contact Details
Name of the person to contact in the case of an emergency.
Health Information
Has your child had or have any of the following:
Are there any specific activities that your child cannot physically do?
Goals
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 for my child before he or she participates in the yoga classes.
    I understand that the teacher cannot give me medical advice on the fitness of my child and the information given by me is used as a guideline to assess my child's ability to do the yoga activities.
  • I fully understand the nature of the classes my child is attending and I will take full responsibility for my child during the class.
    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 child's improper practice at any time.
  • I will notify the teacher before each class begins of any recent injury, illness or surgery experienced by my child.