Registration form for Yoga Classes - Cardiff

Please note that all information given on this form will be treated as strictly confidential.

Name

Date of birth:

Address:

Telephone:

Email:

Since having children, have you experienced any of the following?

Please tick those conditions which have affected you.

Sacro-iliac pain	Back pain	Stiff neck/shoulders
Joint pain	Sciatica	High blood pressure
Dizziness	Depression	Shortness of breath

Have you studied yoga before? Please give details of how long and what style of yoga

Have you suffered any injury or undergone any surgery that may have some bearing on your yoga practice?

Do you have a medical condition that may affect your yoga practice?

Are you taking any form of medication that may have some bearing on your yoga practice?

Please note that if you have answered yes to the last three questions, it is advised that you let your doctor know of your yoga practice and check with your doctor whether it is suitable for you

Why have you chosen to come to this class and what do you hope to gain from it?

Thank you for completing this form.