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YOGA

WITH

DORA

Yoga is a moving meditation that unites the inner and outer you

Each breath is an opportunity to get closer to your optimum balance & health

Classes in Brough, East Riding of Yorkshire

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Yoga with Dora
Student Health Form

Welcome,

Please complete the form below to be able to participate in classes/workshops. This is both to help you get the most benefit out of your practice, while also ensuring your safety and my compliance with the insurance policy.

All data received will be treated confidentially and in accordance with the Data Protection Guidelines.

For my full Privacy and Data Protection Policy

please click here

For ONLINE classes - as always, I will make your safety my absolute priority but as I will not be able to see you fully in person it is even more important that you listen to your body. Please ensure a safe environment around you and ease in your postures.

It is also essential to inform me of any health concerns before the classes.

Full Name

E-mail

Phone number

Date of birth

Full address

Medical / Health conditions: Do you have any current or past medical / health issues (injuries, recovering from surgery, accidents, allergies, diabetes, asthma, respiratory issues, blood pressure issues, headaches, backache, depression, anxiety etc.)? Are you pregnant? Please provide all relevant details below:

Your Yoga experience so far: How much Yoga experience do you have (absolute beginner, participated in a few classes, I have a steady practice, I live on my mat)? Do you currently practice Yoga? If yes, would you like to share for how long, how often and what style do you practice?

What are you aiming for now to achieve with your Yoga practice? You can choose as many as you wish:

Stress relief

Pain reduction

Joint health

Flexibility

Relaxation

Weight managament

Workout

Increased body awareness

Learning to meditate

Personal development

Spiritual development

How did your hear about Yoga with Dora?

Consent to the disclaimer: I participate at my own risk in the yoga classes with Dora Longman and I take full responsibility for my body. According to my doctor I am physically fit to participate in the yoga classes. I release Dora Longman of any future legal liabilities resulting from the yoga sessions. I have read and consent to the Privacy Policy of Dora Longman / Yoga with Dora.

I consent to the dislcaimer

Thank you for filling out the health & consent form, see you on the mat!

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YOGA WITH DORA
Dora Longman
07496404677
yogawithdora.uk@gmail.com
Brough, ERY

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