Artistic Yoga

First Name

Last Name

Email

Phone

Date Of Birth

Gender
Male
Female

Marital Status
Single
Married

Height

Weight

Address

Emergency Contact Details.
In case of emergency, whom to contact?

Name

Relationship

Phone

Name

Relationship

Phone

Do you have any experience in Yoga?
No
Less than Six Months
Six Months to One Year
More Than a Year

If you have experience with Yoga; Which style you practice?

General Information about your health: All facts provided in this area will be merely for record information and will be held in as strictly confidential data.

Are on medication for diabetes or blood pressure?
Yes
No

Describe

Are on medication for any other diseases?
Yes
No

Describe

Do you have any physical limitations?
Yes
No

Describe

Have you been through any surgery recently?
Yes
No

Describe

Do you have any emotional disorders?
Yes
No

Describe

Do you have any knee related difficulties?
Yes
No

Describe

Any other physical or mental condition you would like to report prior to the training session?
Yes
No

Describe

What makes you interested in Artistic Yoga and what do you expect from this training?

Describe

Declaration: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.

Name (Initials)

Date Of Birth

Contact Us

YOGA REGISTRATION FORM