Student Information Form

The following information is required for all new students.

First name:

Surname:

Email address:

Address (first line + postcode):

Please provide details of any health issues or medication you are taking which impacts on your ability to participate in a yoga class or that you would like to make me aware of:

Please confirm which of the following best describes your yoga experience:Beginner Current regular practice Some practice but not regular/recent

If you are pregnant or have given birth in the last 6 months please provide details:

If you will attend classes at my studio - please tell me about any condition or medication I should know about should you become unwell during class. For example if you are diabetic or carry an inhaler:

If you will attend classes at my studio - please advise me of any allergy you have and whether you carry any medication:

All forms of exercise (including yoga) carry the risk of injury. You should listen to your body and not push yourself beyond what feels safe for you. :

If you are not sure whether you are able to practice yoga, you must consult your doctor and follow his/her advice:

If your health changes, you suffer an injury or you become pregnant. Please inform me.:

Is there anything else you want to tell me? :

The information you provide in this form helps me teach you safely. It is treated as confidential and securely stored. My insurers require me to keep this information for 7 years.

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