Indigo Yoga and Therapies - Yoga Registration Form
Indigo Yoga and Therapies - Yoga Classes - Private Yoga Tuition - Corporate Yoga
The following information enables me to know a little about you and your current level of health prior to class. 
All information is treated with the strictest of confidence and will not be forwarded or sold on.
Please visit the Terms and Conditions page as by filling in this form you are agreeing to them.
All fields need to be completed.
Thank You.

Class Details
Class Teacher
Class Venue
Please let us know if you have any condition which may affect your ability to take part fully in the above class, which may create discomfort, worry, or perhaps be a danger to you. If there is anything that is a problem to you that we ought to know about, you must advise us. But if you are in reasonable health we are sure that you will gain benefit and pleasure from our style of exercise.
Please List any physical conditions, limitations or sensitivities that may affect your practice:
Do you suffer from or have any numbness or pain in (check all that apply)
Shoulders
Wrists
Hips
Back
Knees
Feet
High Blood Pressure
Low Blood Pressure
Carpal Tunnel
Arthritis
Osteoporosis
Neck or Spine Injury
*Other
*If other please note
Have you practiced yoga before, and if so, for how long?
In certain instances hands on adjustments may be used for alignment purposes. Are you comfortable with hands on adjustments.
Name
Gender
Address
Phone Number
Date of Birth
Email
Next of Kin (Name and Phone Number)
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

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.

Website Builder provided by  Vistaprint