Your Name (required)
Age (required)
Home Address (required)
Your Email (required)
Your Phone number
Your Occupation
Emergency Contact (required)
Referred By (required) Client referral/Friend ecourse or program Flyer Search engine Advert Yoga Experience
Have you ever practiced yoga before? (required) YesNo
If yes, how often do you practice yoga? DailyWeeklyMonthly
What styles of yoga do you normally practice? Ashtanga Vinyasa Flow Restorative Yin Iyengar Rocket Power Bikram/Hot Hatha/Gentle
What do you want to achieve from private yoga classes? (required) Strength training Flexibility Balance Stress relief Address health concern Alternative therapy Improve fitness Weight management Enhance well-being Injury rehabilitation Positive reinforcement Other reason
Yoga interests (required) Asana (Physical practice) Pranayama (breath work) Meditation Yoga philosophy Other interest Lifestyle and Health
What is your current level of fitness? (required) Very inactive Fairly inactive Average Fairly active Very active
On a scale of 1-10, (1 is lowest, 10 is highest) how would you rate your level of stress? (required) 12345678910
Please review this list and select those conditions that have affected your health either recently or in the past. Broken/dislocated bones Diabetes type 1 or 2 Pregnancy Muscle strain/sprain High/low blood pressure Surgery Arthritis, bursitis Insomnia Seizures Disc problems Anxiety/depression Stroke Scoliosis Back problems Asthma/ short breath Cancer Osteoporosis Heart condition/Chest pain Numbness, tingling anywhere Auto-immune condition (AIDS, fibromyalgia, chronic fatigue, lupus, etc) Other
If any of the information on this form needs further detail, or if there is anything else to share, please do so:
Please read the following information and accept below. I am delighted to welcome you as a yoga student at Tali’s Yoga. The following information will help you get the most out of your yoga classes and clarify the instructor/student relationship. I believe that Yoga is more than physical exercise. It is a transformative practice that integrates body, mind and emotional tensions to arrive at deeper levels of relaxation and awareness. As with any physical activity there is a risk of injury associated with yoga. The decision to perform any exercise is down to the individual, and the instructor (Tali) cannot accept responsibility for problems during or outside a class. The participant agrees to take on full responsibility for their actions within the class and shall work within their own limits. If students have any inquiries or health concerns it is their responsibility to notify Tali so that she is aware of your limits. If you are in doubt as to your fitness, please consult your physician beforehand. Tali shall not be held liable for any injury, loss or damage to property and/or persons sustained during or as a result of participation in this class. I agree to listen to my body and monitor myself during every class session. I agree to the Terms and Conditions as stipulated by Tali, including the cancellation policy. I accept the statementI do not accept the statement
