Private Yoga Registration Form

First name

Last name

Email

Phone

Birthday

Month

Day

Year

I would like to receive news from Calm Heart Yoga

Emergency Contact Name

Emergency Contact Phone

What is the main reason for requesting private yoga? Please check all that apply.

I am a beginner

I would like to deepen my practice and learn advanced poses

I would like a personalised yoga practice or plan

To address an ailment or injury

Other (please specify)

Have you practiced yoga before?

Yes

No

Please describe your yoga experience and current yoga practice?

What do you hope to gain from private yoga sessions?

What would you like to work on in our session/s?

Please list any relevant injuries, ilnesses or health conditions? (e.g. asthma, high/low blood pressure, insomnia, heart, lung, back or neck problems, thyroid conditions etc.)

If you require a personalised yoga practice or plan, please specify: a) what you would like to achieve from your plan, b) how long you would like the practice e.g. 30/60 mins, c) how often you are able to practice p/week?

I understand that it is my responsibility to inform my teacher of any relevant changes to my health and assume full responsibility for any physical injury or damages that might occur as a result of participating in yoga classes & workshops at Calm Heart Yoga.

Signature

Signature field is empty.

Private Yoga Registration Form

Acknowledgement of Country