YOGA with EM

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First name

Last name

Date of Birth

Have you practiced Yoga before ?

Yes

If yes for how long ?

Please let me know about any limitations or injuries.

Emergency Contact and Phone Number

* Please note all of the information on this form is kept strictly confidential

I declare that the info I’ve provided is accurate & complete

I acknowledge and understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will not perform any postures to the extent of strain or pain. I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking of the class.

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YOGA with EM​

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YOGA with EM