Yoga & Mindfulness Registration and Waiver Form

Zen Yoga, Mindful Movement, Meditation and Mindfulness
I am interested in attending:

Zen Yoga Meditation Mindfulness for Wellbeing Mindfulness for Insight
Name

First Name Last Name
Email
example@example.com
Phone Number
Emergency Contact
Phone Number
Anything else you would like to add:
Are you currently experiencing any of the following?

Anxiety Asthma Back pain Depression Diabetes Dizzy/Fainting spells Epilepsy Heart problems High blood pressure Joint pain Low blood pressure Muscle pain Pregnancy / pre or postnatal Other (to be discussed with the teacher)
If at any time during a yoga or movement session, you feel discomfort or strain, gently come out of the posture.

Listen to your body and rest at any time during the class.

If thoughts, feelings and emotions come to the surface, rest, take it easy and allow them to pass.
Disclaimer (Please Read Carefully)

I understand that yoga, meditation or mindfulness are not substitutes for medical attention, so I should consult a health professional if I have any concerns.

I will not perform any postures that cause strain or pain.

I do not have Covid-19 symptoms and I am not self-isolating.

I will abide by social distancing rules and sanitisation rules at the venues I use.

I will bring my own equipment including yoga mats, blankets and blocks, while Covid-19 restrictions are in place.

I accept full responsibility for my health during yoga, meditation and mindfulness classes and I will inform my teacher of any changes to my health.
Date

Month Day Year
Date
I agree to all of the above and that I have been open and honest about my health

Please tick
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