Just Yoga New Students Registration Form

Please complete the following registration form and submit your new student registration. This will enable the teachers to accommodate any medical conditions you may have.

Required information fields are marked with an *.

First Name *

Surname *

DOB

Gender *

Address:

Suburb

Telephone

Mobile *

Email *

Yoga postures are physically demanding and can have a strong effect on the participant. It is important that your teacher is aware of your physical condition. The following questions are designed to assist in informing them of your physical and medical condition. All information will be treated strictly confidential.

Are you pregnant? *

Please indicate is you are suffering from any of the following medical conditions:

Medical conditions? *

High blood pressure Glaucoma Hernia Back or other joint pain No Medical Conditions

Do you have any other medical conditions or injuries? Please provide details?

Other medical conditions or injuries.

Have you recently had surgery or other medical treatments? Are you taking any medications? Please provide details?

Surgery or other medical treatments.

If you have any queries about this questionnaire contact David McLaughlan on 0418 923 791.

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