Sculpt & Stretch Workshop registration

Which class are you interested in

Name

Town

Telephone

Email

Do you have children:
YesNo

If yes, how old are they

Are you currently breast-feeding:
YesNo

Have you done Yoga before?
YesNo

What style?

Have you done Restorative Yoga before?
YesNo

Have you done HIIT training before?
YesNo

Do you currently do any physical activity:
YesNo

If yes, what kind

What would you like to gain through the workshop

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

Do you currently experience any of the following. Tick any relevant symptoms
TirednessSleep disturbancesAnxiety / DepressionAching groinsAnaemiaDiabetesLower Back PainSciaticaVaricose VeinsDiastasis recti

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor:
YesNo

Do you feel pain in your chest when you do physical activity:
YesNo

In the past month, have you had chest pain when you were not doing physical activity:
YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness:
YesNo

Do you have a bone or joint problem (e.g. back,knee or hip) that could be made worse by a change in physical activity:
YesNo

Is your doctor currently prescribing drugs e.g. water pills for your blood pressure or heart condition:
YesNo

Do you know of any reason why you should not try physical activity:
YesNo

If you answered YES to any of the above questions, then you are required to talk to your doctor by phone or in person BEFORE participating in the workshop. You are advised to DELAY participation if you feel unwell or have a temporary illness. You must inform your fitness professional of any changes to your health status.:

Do you have any allergies or dietary requirements:
YesNo

If yes, what kind

How did you hear about the class?

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Email: maryline@yogaspirits.co.uk

We’ll answer your query in the shortest time and hopefully get the chance to help you relax and strengthen for life!