Postnatal Yoga Registration

POSTNATAL YOGA Registration Form
Please complete this form to register your place in class. All information is to help me tailor the class to your needs and will remain confidential. Please see the privacy policy for more information on how we handle data collected through this form

* Indicates required field

Name *

First

Last

Email *

Phone number *

Address *

What is your baby's name? *

What is your baby's Date of Birth DD/MM/YY *

Have you attended a 6 week check up with your GP and been told you are okay to attend a yoga class? (it may be longer than 6 weeks for caesarean) *

Which date would you like to start coming to the class? *

Is this your first baby? If not please give ages of older children *

How are you feeding your baby? (eg breast/bottle/combination) *

Please give any relevant details about your pregnancy and birth which may affect your yoga practice. Include whether your baby was born by vaginal delivery, with forceps etc or by caesarian and whether you had an episiotomy. *

Please give details of any injuries or medical conditions you have which may affect your yoga practice (eg High/low blood pressure, knee, back or neck injuries, asthma) *

Please give details of any condition your baby has which may affect their ability to participate in the class *

I already have my own yoga mat *

Yes No

I am happy for Salome to pick up my baby during the class eg during the postnatal yoga *

Yes No

Where did you hear about the class? *

DISCLAIMER. I, the above named participant, understand that all practices are optional; I hereby waive any and all claims I have now or in the future against Still Space Yoga and Salome Chasey. I take full responsibility for my body and my baby. If I feel dizziness or pain I shall stop the activity immediately and let my teacher know. If I have any doubts I will seek the advice of a medical professional before proceeding with the yoga class. *

I agree I do not agree

Submit

POSTNATAL YOGA Registration FormPlease complete this form to register your place in class. All information is to help me tailor the class to your needs and will remain confidential. Please see the privacy policy for more information on how we handle data collected through this form

POSTNATAL YOGA Registration Form
Please complete this form to register your place in class. All information is to help me tailor the class to your needs and will remain confidential. Please see the privacy policy for more information on how we handle data collected through this form