Student Health Form

Prior to joining me on the mat, kindly fill out the Student Health Form provided below. This form will request certain personal information, including your name, contact details and any health issues that may affect your Yoga Practice. Providing accurate information is crucial for ensuring your safety and wellbeing during the class. If you have any questions, feel free to reach out to me via message or phone call.

I'm looking forward to having you in the class!

First Name

Last Name

Phone

Email Address

Date of Birth

Please list any medical conditions or injuries that I should be aware of?

Please list any reasons or aspirations for joining yoga class

I declare all information provided is accurte and that I take full responsibility for my health during the practice, including any injuries. I will inform my yoga therapist of any medical changes

I understand that I am participating in Yoga classes or any other exercise programmes offered by Sylwia, during which I will receive instruction about yoga therapy, physical exercise, or health. I am aware that it is my responsibility to listen to my own body and signs of pain or discomfort and react accordingly. I will inform my instructor of any of the above as well as any injuries and medical history that could affect my class. I understand it is my responsibility to consult GP regarding my participation. I represent and warrant that I am physically fit and I have no medical condition that would prevent my participation. I agree to discharge Sylwia and La Viva Yoga from any claim, cause of action or liability relating to any incident that may occur.

Photography: I consent to be photographed while taking a yoga class with La Viva Yoga. These photographs are the property of La Viva Yoga and no compensation will be given to me if these photographs are used by La Viva Yoga for promotional purposes.

Thanks for submitting!

Student Health Form

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