Full Name *

Email Address *

Mobile Phone Number *

Address *

Age Group * Select age Under 16 years old 17 - 34 years old 35 - 44 years old 45 - 64 years old 65+ years old

Have you done yoga before? No Yes If yes, what type(s) and for how long?

What is your main reason for wanting to do Yoga?

Which aspects of yoga most interest you? Physical posture (asanas) Relaxation Philosophy Breathwork (pranayama) Meditation Other (please specify)

How did you first hear about this class?

Do any of these health conditions apply to you? High blood pressure Low blood pressure/fainting Arthritis Diabetes Epilepsy Heart problems Asthma Depression Detached retina/other eye problems Recent fractures/sprains Recent operations Back problems Knee problems Neck Problems Recent pregnancies

Do you have any other conditions which affect your mobility or are likely to cause you concern when doing Yoga? No Yes Please briefly describe your medical conditions: