Pregnancy Yoga Registration

PREGNANCY 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 *

How many weeks pregnant are you? *

What is your baby's estimated due date? DD/MM/YY *

On what date would you like to start classes? *

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

Please tell us any relevant details about your pregnancy which may affect your yoga practice (eg High/Low Blood Pressure, Pelvic Pain (SPD), Gestational Diabetes, Placenta Praevia *

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

I already have my own yoga mat *

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. 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

PREGNANCY 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

PREGNANCY 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