Mums & Bubs Yoga Registration Form

    Personal Details

    Your Name

    Your Email

    Your Date of Birth

    Your Phone

    Your Address

    Bub's Details

    Bub's Name

    Bub's Date of Birth

    Medical Considerations

    1. Is this your first baby?

    YesNo

    2. Did you have any complications, medical intervention or procedures during birth?

    YesNo

    If yes, please explain below:

    3. What kind of birth did you have?

    C-SectionVaginal

    4. Was your birth ...

    EarlyLatePremature

    5. Please give details of any of past injuries, fractures, dislocations and how long ago.

    Your Yoga Experience

    1. Have you done yoga before?

    YesNo

    If yes, for how long, where and what kind?

    2. What would like to get out of yoga?

    RelaxationStress managementStrengthRelief from back painRelief from neck painFurther connection with babySocial InteractionOther

    3. Any further requests, special needs or concerns?

    4. How did you find out about Professional Yoga?

    Agreement

    I understand that the instructions given throughout classes are intended only as a guidance with due care and skill by a qualified instructor. It is therefore my responsibility to:

    1. Ensure that I am in satisfactory physical condition and that I have no medical or other reason why I am not capable of engaging in exercise, and that such exercise would not be detrimental to my health, safety, comfort or physical condition. I have undertaken my 6-week post-natal check and ready to commence our yoga sessions.

    2. Adjust my practice according to my limitation to ensure no personal injury occurs.

    3. Inform the teacher before the class of any recent change to my physical condition.

    4. Stay away from Mums & Bubs Yoga whilst my baby or I are suffering from any infections or contagious illness, disease or other ailment or whilst suffering from any physical ailment, such as open cuts or sores or infections where there is a risk, however small, to other participants and their babies.

    5. Mums & Bubs Yoga is a group session, not personal training, and therefore other participants must be considered. It is my responsibility to care for my baby at all times while attending Mums & Bubs Yoga.

    I consent to the use of my and my baby’s image being used in any promotion or other material in relation to the business.
    AgreeDo not agree

    I hereby declare that I release Professional Yoga of any responsibility for any injury sustained and that I will take full responsibility for my baby and myself during yoga classes.

    I accept the agreement above.

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