Registration - YOGAJAK

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Registration for classes at YogaJak

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Age *

Under 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 Over 55

How did you hear about YogaJak? *

Health and Previous Yoga Experience

Have you practised yoga before? *

Yes No

Have you ever had or do you have any of the following? If yes, please give details:

High blood pressure *

Yes No

Details *

Low blood pressure *

Yes No

Details *

Arthritis *

Yes No

Details *

Diabetes *

Yes No

Details *

Epilepsy *

Yes No

Details *

Heart/Stroke condition *

Yes No

Details *

Asthma/Breathing Difficulties *

Yes No

Details *

Depression *

Yes No

Details *

Detached retina/other eye problems *

Yes No

Details *

Recent operations/injuries *

Yes No

Details *

Back problems *

Yes No

Details *

Knee/ankle problems *

Yes No

Details *

Neck/shoulder pain *

Yes No

Details *

Recent fractures/sprains *

Yes No

Details *

During the class listen to your body and come out of poses if necessary. Listen to instructions carefully, remember that yoga is non-competitive and always let common sense prevail *

I have read the above cautions and answered all the questions to my satisfaction. I hereby waive the right to all and any claim against the teacher for any injury or adverse change in my state of health arising directly or indirectly from my participation in classes. I will inform my yoga teacher of any medical changes. I understand that when I purchase a term pass from YogaJak, this reserves my place in the selected term. In respect of the commitment that we are both making, I understand all term purchases are non-transferrable and non-refundable in whole or in part. I understand If I miss a class I may attend an alternative class during the same term (make up class) and I can have a maximum of 2 make up classes per term (bookings required).

Submit

YogaJak
Yoga For Men
at Joymamma Studio
7/104-106 Brisbane Road
(behind Nutrition Supplement Co)
Mooloolabla, Sunshine Coast, Qld

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YOGAJAK

Yoga For Men
Joymamma Studio
7/104-106 Brisbane Road
(behind Nutrition Supplement Co)
Mooloolaba
Sunshine Coast, Qld

T: 0400 611 957

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