Indigo Yoga and Therapies - Pregnancy Yoga Form
Indigo Yoga and Therapies - Yoga Classes - Private Yoga Tuition - Corporate Yoga
Pregnancy Yoga Questionnaire
Name
Address
Home Phone Number
Mobile Phone Number
Emergency Contact Details
Doctors Name and Address
Due Date
1st, 2nd, 3rd etc. baby
Previous Yoga Experience
Is there history of difficult or complicated pregnancies? If so, what ?
Previous Birth Experience (eg. C-Section, Active birth, Induction, Water birth, Difficulties etc.)
Please check any health problems you have had before and during your pregnancy
Back Pain
Heart burn
Varicose veins
Low lying placenta
Swelling
Constipation
Sleeplessness
Low blood pressure
High blood pressure
Diabetes
Heart Disease
Asthma
Other
If other, please note.
Are you on any medication
Any other relevant information
Please tell me at the beginning of each session of any changes to your health and wellbeing.
It is advisable to wait until the 2nd trimester before starting yoga classes, unless you already practise yoga regularly.
Please read the Terms and Conditions and the Release and Waiver statement below as signing and submitting this form is your agreement with all.
Signature
Date
Please let your midwife know you are commencing yoga and check with her if you are unsure of the suitability of this type of exercise for you.

It is important that you observe instructions on safety and technique and only do what feels right for your body.

Release and Waiver Statement:

As the student, I hereby acknowledge all details are correct to my knowledge and I understand the instructions given during class are intended as guidance only, I shall respect any limitations and listen to my body accordingly to work mindfully, I will take full responsibility for myself at all times.

I am aware of the physical injury risks involved with exercise and understand it is my responsibility to consult with my physician prior to my participation in any classes.

I agree that Indigo Yoga and its owners are not responsible for personal injury or illness sustained during my participation in the activities and programs offered by Indigo Yoga, I understand that while all due care will be taken by the teacher, they cannot be held responsible for any injury resulting from my improper practice at any time, to ensure that no personal injury occurs I agree to adjust my practice according to my limitations and the decision to perform any yoga postures remains mine.  It is my responsibility to notify the teacher before each class of any recent injury, illness, surgery or pregnancy so modifications can be advised.

I understand that Indigo Yoga is not responsible for any damage to my personal property of any kind or nature, or in the event of loss, damage, unauthorised use or theft to any personal property that I bring to any classes held in any location.

I have read the Terms and Conditions and agree with all.




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