Please complete our health questionnaire before booking. Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Mobile Number *Emergency Contact Name *FirstLastEmergency Contact Mobile Number *Please choose your age range:Under 1818 to 2930 to 3940 to 4950 to 5960 to 6970+Have you practiced yoga before? If yes, how long have you been practicing for and what style? *Why do you want to attend yoga classes? *Have you been hospitalized in the last 12 months? *YesNoAre you pregnant? *YesNoDo you have any medical condition, health related issue or injury? *YesNoIf you answered "Yes" to any question, please provide details that may be helpful for your yoga teacher to know:Is there anything else you would like to make your teacher aware of? If yes, please provide details below:Disclaimer Terms *AgreeI agree to the following: During a yoga class I will self-regulate which means resting if I need to, or adapting movements to suit my own body and condition. I will let the teacher know if I am experiencing pain or discomfort during the class so that the movement or position can be adapted, modified or left out. I will opt out of any exercise or position at any time, for any reason, and in particular if it is causing pain or discomfort. The information I have provided on this form is complete and accurate. I understand that participating in an exercise class involves risk of injury; I agree to be solely responsible for any injuries sustained by me as a result of my participation in this class or any future classes I take with Suivness/Susan Dowling. I am fully aware of the risks involved. I understand that it is my responsibility to consult with a doctor prior to and regarding my participation in any Yoga class offered by Suivness/Susan Dowling. I represent and warrant that I am physically fit and have no medical conditions that would prevent me from participation. I assume full responsibility for any injuries or damages, known or unknown, which I might incur as a result of participating in yoga classes. I knowingly, voluntarily, and expressly, waive any claim I may have against Suivness/Susan Dowling for injuries or damages that I may sustain as a result of participating in the yoga classes. I confirm I have read and fully understand this form. Sign Initials & Date *e.g. AA 14/01/2020Submit