Your Date of Birth
1. Please describe the current state of your health:
2. Are you taking any long-term prescription or over-the-counter medication?
3. Do you suffer from any of the following?
AllergiesAIDS/HIVAsthmaBack PainChronic FatigueEpilepsyFibromyalgiaGlaucomaHearing LossHeart TroubleHerniaHypertensionOrthopedic ProblemsPregnancy (due date)Respiratory ProblemsSurgery (recent)
4. Please describe any other health or medical conditions below:
5. Please ask any questions or voice any concerns that you have about participating in yoga classes:
6. Is there anything else we should know about you or your health?
I accept the terms of the Professional Yoga Disclosure and Release Form.
Once you register above, please purchase your ticket.