Medical Form

Woodland Elements Yoga
Medical History Form

About You

* Indicates required field

Name *

First

Last

Date of birth *

Age *

Phone Number *

Mobile Phone Number *

Email *

Address *

GDPR statement *

Yes No

In order to comply with GDPR, it is necessary for me to check whether or not you are happy for me to retain your contact details, and to send you information that I think may be useful to you, including training and events, and relevant updates. I only hold information when it is necessary to do so and where you have given me permission to do so.

In case of emergency

Please contact *

Relationship *

Emergency Contact Phone Number *

Yoga Experience

Yoga Experience *

Beginner 2-3 years practice Experienced

Type of yoga (if known) *

How did you hear about this class / workshop *

What are you hoping to gain from yoga classes? *

Medical History

My general health is: *

Disclaimer *

Yes

By submitting this questionnaire, you are confirming that the contents are true and accurate to the best of your knowledge. Please notify me of any changes to your responses in this health questionnaire before participating in future classes.
As a Dru Yoga and Shakti Dance teacher, I am not qualified to express an opinion as to whether you are fit to safely participate in any of my Dru Yoga or Shakti Dance classes. You must obtain professional or specialist advice from your doctor or health professional before participating if you are in any doubt.

Please always let me know before the class if this is your first-time practicing yoga or if you are not confident about your experience and/or ability. Where you are taking part in live-streamed classes, please note that I may not be able to see you at all times. Where you have declared a health condition, please contact me before the class if you would like to be provided with suitable modifications or adjustments. Please note, where you are taking part in a pre-recorded class, you will not be able to request specific adjustments or modifications.

In all classes whether face to face, live streamed remote or pre-recorded remote, always follow the safety instructions and listen to your body. Where a movement or class is beyond your experience or ability, feels too difficult for you, or you experience any discomfort, please do not continue the movement or class.

You accept liability for any injuries or harm you might sustain as a result of participating in live or pre-recorded Dru Yoga or Shakti Dance classes.
You also take full responsibility and liability for your own health and wellbeing during the class and when you practise anything taught in my live or pre-recorded Dru Yoga classes.

I agree to receiving newsletters from Woodland Elements, I understand I can opt out at any time *

Yes No

Submit

Woodland Elements YogaMedical History Form

About You

In case of emergency

Yoga Experience

Medical History

Subscribe for all Woodland Element's latest news

Woodland Elements Yoga
Medical History Form