New Yoga Student Registration Form New Yoga Student Registration Form It will help me tremendously if you could fill in this form. It will give me a good understanding of your general health, and any special pregnancy or post-birth conditions you may have so I can prepare any modifications ahead of the class. Client's DetailsMother's Name* First Last Email* Enter Email Confirm Email Your email address will be automatically added to my mailing system when you book a class. I usually send email reminders a week prior to the start of a new yoga term which run in six or seven-week cycles. If you do not wish to receive these please let me know and I will take you off the list. You are able to remove yourself from my mailing list at anytime if any unwanted mail slips through.*Yes I'm cool receiving updates.Thanks, but no thank you. Estimated due date or babies date of birth* Date Format: DD slash MM slash YYYY Is this your first pregnancy? Which number child is this?*FirstSecondThirdFourthDo any of the following apply to you?* Heart Condition Asthma Epilepsy High Blood Pressure Low Blood Pressure Physical Condictions/ injuries If you ticked yes to any of the above or have any other health or pregnancy/ post-birth related conditions please give details:Have you practiced yoga before?*YesNoWhat benefits would you like to receive from your yoga practice? Please tick as many as apply.* Stress Relief Relaxation Labour and Birth Preparation Pregnancy Health Childbirth Education Learn Breath Practices for Birth To meet other pregnant women Connect with my growing Baby To meet other Mum's & Bub's Energy boost to cope with sleep deprivation I need a good stretch Emergency Contact Name:* First Last Emergency Phone number:*I agree to take full responsibility for my yoga practice, taking care not to exceed my limits in the practice of yoga and for adjusting my practice when necessary to avoid any injury or discomfort.* I agree It is my responsibility to inform my yoga teacher of any changes in my health that may affect my practice.* I agree I have received advice from my doctor that yoga is suitable for me, or I accept the risk of practising yoga without such advice.* I agree How did you hear about Yoni Yoga Birth?*CommentsThis field is for validation purposes and should be left unchanged.