Yoga Registration

Online Registration

Name

Date

Address

Home Phone

Work Phone

Email

Occupation

Female

Male

Age

What are your Reasons for taking Yoga Classes?

Learn to Relax

Recovery from illness or injury

To stay healthy

Improved flexibility

Increased physical strength

Decrease stress

Learn about Meditation

Find peace of mind

Previous Yoga/Meditation Instruction (When, Where, with Whom)

Sources of Information on Yoga?

Friends

Books

TV/Videos

Yoga Teachers

Other

Do you have a Daily Spiritual Practice?

Study

Prayer

Contemplation

Meditation

Yoga

Other

What other activities do you engage in? (hobbies, sports, leisure, exercise)

Overall Health

Excellent

Good

Fair

Poor

Health Concerns

Do you have any physical conditions or challenges for which posture practice will need to be adapted, such as:

Pregnancy

Effects from surgery/injury

Joint pain/discomfort

Muscle pain/stiffness

Breathing difficulty

Heart condition

Depression/Anxiety

Medications

Digestive problems

Please explain any of the above

What are your goals or intention for practicing yoga?

Accept terms and Conditions
(Waiver of Rights)

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