New Adult Student Form All information we collect about you will be held in the strictest confidence and according to our privacy policy. Your Full Name* First Last Your Email* Date of Birth* Date Format: DD slash MM slash YYYY Your Phone Number*Have you done yoga before?*YesNoWhat 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) Chanting & Healing Meditation Relaxation Breathwork (pranayama) Ashtanga (8 limbs of yoga) Are there any other aspects of yoga that you're interested in but aren't listed above?Do any of the following health conditions apply to you? If yes, give details such the dates you are/were affected by the conditions and if taking medications etc.High blood pressure*YesNoLow blood pressure*YesNoArthritis*YesNoDiabetes*YesNoEpilepsy*YesNoHeart problems*YesNoAsthma*YesNoDepression*YesNoDetached retina/ other eye problems*YesNoRecent fractures/ sprains*YesNoRecent operations*YesNoBack problems*YesNoKnee problems*YesNoAre your pregnant?*YesNoNeck problems*YesNoRecent pregnancies*YesNoPlease give us more details about your condition(s)*Do you have conditions which affect your mobility or are likely to cause you concern when doing yoga?*YesNoPlease give details:How did you first hear about this class?I take full responsibility for my health during the yoga classes, including any injuries. I will inform my yoga teacher of any medical changes.* I agree Consent to store your data*We collect your personal contact details so that we can get in contact with you about our products and services. Please read our privacy policy for full information about Going Yogi protects and manages your submitted data. I agree to the privacy policy.PhoneThis field is for validation purposes and should be left unchanged.