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Home
Online Yoga
Online Yoga Practice
Camphill Online Yoga Practice
Join Us
Join Online Yoga Practice
Join Camphill Online Yoga Practice
Gallery
About me
Testimonials
Contact
Join Online Yoga Practice
Join Us
Online Yoga Practice
Full Name:
Email
Tel No. Home
Tel No. Work
Tel No. Mobile
Address
Age Group:
Under 16
17-34
35-44
45-64
65+
Have you done Yoga before?
Yes
No
If yes, what type(s) and for how long?
What is your main reason for wanting to do Yoga?
Which aspects of Yoga most interest you? Please tick as many as you wish:
Physical postures (asanas)
Relaxation
Chanting& Healing
Breathwork (pranayama)
Meditation
Ashtanga
Other aspects (please say which):
Apart from the above aspects, are there any other you have practiced?
Do any of these health conditions apply to you? Please answer all questions Yes or No.
High blood pressure
Yes
No
Low blood pressure/fainting
Yes
No
Arthritis
Yes
No
Diabetes
Yes
No
Epilepsy
Yes
No
Heart problems
Yes
No
Asthma
Yes
No
Depression
Yes
No
Detached retina/other eye problems
Yes
No
Recent fractures/sprains
Yes
No
Recent operations
Yes
No
Back problems
Yes
No
Knee problems
Yes
No
Neck problems
Yes
No
Recent pregnancies
Yes
No
Are you pregnant?
Yes
No
Do you have any other conditions which affect your mobility or are likely to cause you concern when doing Yoga?
Yes
No
If you have answered Yes to any of the above health questions, please provide further details.
How did you first hear about this class?
I have read and agree with the Yoga With Leasha
Privacy Policy
and
Liability Policy
Agree
Which online group would you like to join?
Facebook
Whatsapp
both
none
Signed (YOUR NAME)
Date
JOIN
