Dru Yoga Cape Town -Dru Yoga Personal Info form

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Dru Yoga Personal Info form

Thank you for your response. ✨

Name(required)

Surname(required)

Date of Birth(required)

YYYY-MM-DD

Phone number(required)

Email(required)

Next of kin/Emergency Contact

Name(required)

Surname(required)

Phone number(required)

Personal Health

Please note:

The following information is treated as confidential. Please select from the below if you experience any of the conditions and provide details that may affect your ability to do yoga. Classes may be able to be tailor made to your needs. Should you not wish to share medical information please ensure you have checked safety practices with your health practitioner.

My general health is…. (required)

Excellent Good Maneagable Challenging

I am pregnant *(required)

Yes No

I experience / have experienced

Heart Conditions Breathing problems (more info below) Joint problems Hyper-mobility Back/neck pain Lack of energy Depression Headaches Uncontrolled mHigh blood pressure Anxiety

Other health issues

Breathing

I feel anxious when bringing attention to my breath I struggle to take a deep breath I struggle with the exhale I believe that deep breathing is good for me I suffer from rhinitis (blocked nose)

Please state any other breathing related issues

I am interest in the following class

Observatory Thursday 17.45-18.45 Stonehurst Friday – 10.00-11.00

Classes are offered on a block payment system of 4 classes to be used within 6 weeks. This allows you to get the best out of the classes and keeps the classes consistent. Unfortunately all payments are final and I can not refund or transfer class passes or memberships, for any reason. Advance bookings for classes where payment is required can be cancelled up to 24 hours before the class, after this time refunds or transfers of credit will not be available. By making a booking with Dru Yoga Cape Town you take full responsibility for your own health and wellbeing during the class and when you practise anything taught in your yoga class. By submission of this form you acknowledge that you have read this disclaimer.

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