Name

First Name

Last Name

Phone Number

Date of Birth

DD/MM/YYYY

Next of Kin: Name and Contact Number

How did you find out about YogaHara?

If it was a friend who referred you, please tell us their name so we can pass on the YogaHara Love

Can we add you to our mailing list?

We only send information relating to YogaHara

Have you practiced yoga before?

If yes, please give details.

What brings you to yoga?

What do you hope to get out of yoga?

Details

Please give details of anything you have ticked above, or any other information you think we need to know about you.

Disclaimer

I understand that I am responsible for my own health and wellbeing. During the class I will listen to the instructions carefully and then listen to my body. I will not do any practice that I believe is not suitable for my body or current state of mind at any particular time. If I have any doubts I will ask for a modification. I will consult my doctor on any health concerns. Signed:

First Name

Last Name

Thank you!

We will look forward to seeing you in class.

You can read more info about preparing for your class here.

YogaHara Health Questionnaire