Post natal yoga registration

Which class are you interested in

Name

Town

Telephone

Mobile

Email

Date and place you gave birth

Boy/girl/twins name(s)

Are you currently breast-feeding:
YesNo

Have you undergone: epidural/c-section/natural birth/water birth

List any particular conditions which may have affected your pregnancy or labour eg SPD/diabetes

Baby came late, low placenta etc

Have you done Yoga before?
YesNo

What style?

Have you done Pregnancy Yoga before?
YesNo

If yes, did it help you during labour?
YesNo

How?

What would you like to gain through post natal Yoga classes

Was this your first pregnancy?

If no, please give age of children

Previous difficulties/miscarriages?

If yes, please give details

Do you currently experience any of the following. Tick any relevant symptoms
TirednessSleep disturbancesSPDConstipationAnxiety / DepressionAching groinsAnaemiaDiabetesPilesLower Back PainSciaticaLow Blood PressureVaricose VeinsOedema (swollen joints)Diastasis rectiHigh Blood Pressure

Please give details of any other health issues you may encounter:

Last, have you suffered any injury or undergone any surgery (i.e. knee surgery) which could affect you Yoga practice? If so, please give details, thank you

Do you have any allergies or dietary requirements:
YesNo

If yes, what kind

How did you hear about the class?

Would you like to keep in touch with Marylines news of classes, workshops, audio and video material. If yes, we'll add you to our mailing list. Your details won't be shared with anyone else.

Responsibility for my health
By ticking this box I declare that as far as I am aware, I have disclosed to YogaSpirits all information regarding my health (and the health of my baby/ies) relevant to the practice of yoga and/or meditation. I take full responsibility over the health of myself (and my baby/ies) in the yoga sessions (face-to-face or online) and for all applications of yoga I may practice outside the classes both now and in the future. I understand that any uses to which the recommendations, ideas and techniques are put are at my sole discretion and risk. Should there be any medical changes I will consult my doctor and inform Maryline as my yoga teacher

Covid 19
By ticking this box I declare that I have read, understood and agree to abide by YogaSpirits Covid-19 policy and any updates as advised (link in website footer) I confirm that I attend classes entirely at my own risk and I hereby release, waive, discharge YogaSpirits from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me (or my baby/ies) related to COVID-19 while participating in any YogaSpirits activity that may lead to unintentional exposure or harm due to COVID-19.

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Email: maryline@yogaspirits.co.uk

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