Health Status Form

Full name

Address

Date of birth

Your email

Phone

Emergency contact name & number

Do you have any medical conditions, injuries or physical limitations that may impact your safety, or the safety of others, whilst performing yoga? If so, please detail in the box below, or state N/A

Are you taking any medications, long or short term, and if so what are they for? If so, please detail in the box below, or state N/A

Do you have any medical conditions that require the approval of your doctor or specialist for you to engage in yoga? If so, please detail in the box below, or state N/A. If yes, please ask your doctor for a written medical clearance and provide it to Redfern Yoga Space before your first class.

Do you acknowledge that yoga involves physical activity and do you accept any potential risk associated with your participation in yoga classes? Please select Y/N below

YesNo

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