Class Registration

Please register your intention to attend a La Vida Yoga Course or Workshop by registering your details here below. All information is treated confidentially.

First Name
Last Name
Date of Birth
Address
Suburb
Postcode
Phone
Email
Occupation
Emergency Contact Name
Emergency Contact Number
Course
Are you:	Pregnant
Please select below if you have any of the following:
High Blood Pressure Low Blood Pressure Back pain / injury Neck pain / injury Diabetes Heart condition Epilepsy	Headaches Asthma Knee problems Anxiety Arthritis Osteoporosis
If you selected any of the above, please provide further details as well as any physical movements or illnesses that cause you difficulty or pain:
Please describe any yoga experience you have, including length of time and style of practice:
What are your current goals and reasons for wanting to practice yoga:
Where did you hear about us?
How do you plan to pay?
Agreement I, the above named, represent and agree to the following provisions: 1. That I am participating in yoga classes offered by La Vida Yoga during which I will receive information instruction about yoga and wellbeing. 2. I understand that it is my responsibility to consult a physician prior to and regarding my participation in a yoga class. 3. I understand that it is my responsibility to advise the yoga instructor of any health concerns, injuries, illnes pregnancy prior to the commencement of all classes. In addition I undertake to continuously inform La Vida and it’s instructors of my health status whilst attending the yoga classes. 4. I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur result of participation. I will not hold La Vida Yoga, or any of its instructors responsible for any injuries suffered me. I knowingly, voluntarily and expressly waive any claim I have against La Vida Yoga and its instructors for injuryies or damages that may occur as a result of participation. 5. I consent to receive regular email contact from La Vida Yoga. I understand that my personal information will not shared with any third parties. 6. I hereby acknowledge that the information that I have provided is accurate and fully reveals the nature of my state of health as of the date of this document. I have read the conditions above and fully understand its contents. I agree to the terms and conditions stated above.