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NurtureWorks Yoga & Qigong Class Registration Form

Claim your 4-Week Unlimited Class Trial by filling this in before your first session (or select one trial class).

You can register here for the following classes at the Signal Box Community Centre:

  • Hatha Yoga (Five Elements)
  • Well-Woman Yoga
  • Five Elements Qigong

For classes at Satyam Yoga studio, please register directly with Satyam.

Thanks for sharing your personal data. The information helps to make the classes safe, enjoyable and beneficial for all. Most questions are optional. Please focus on the sections relevant to and keep your answers concise, sharing only what you are comfortable with, while being sure to let me, as your teacher, know any key facts that I need to know about your health.

NurtureWorks is committed to safeguarding your privacy and will never share your data with third parties for marketing purposes. Your health data will be kept strictly confidential. See my Privacy Policy.

Please note - the trial offer covers my three regular weekly classes at the Signal Box.

Yoga and Qigong Class registration Stripe version
Post Town/City

Yoga & Exercise

General Health and Medical Conditions

Women's Health

The first four questions help keep all classes safe and relevant. The last two are particularly important for Well-Woman Yoga.

Medications etc

Some guidelines


  • Try not to eat for at least 2 hours before class. If impossible, please eat lightly.
  • Wear comfortable clothes with socks you can remove (not tights).
  • I have Yoga mats and other equipment, but do feel free to bring your own Yoga mat if you wish.
  • Try to arrive 5-10 mins before class. If you are held up, please enter quietly.
  • Turn your mobile phone off before the class starts.


  • I declare that the information I have given here is correct and that as far as I am aware I can participate in Yoga/Qigong classes without any adverse effects.
  • I understand it is my responsibility to inform my teacher of any injury or change in my health.
  • I understand that, should I have any concerns, I should consult the teacher before continuing, and my GP if required.
  • I understand that I should inform my teacher if I am uncomfortable or in pain during or after the class.
  • I am aware that hands-on adjustments may be made in class and give my consent.
  • I consent to Nurtureworks processing and storing (in accordance with
    Privacy Policy) the personal health data that I have given above to help improve customer experience by keeping classes safe and relevant to student needs.


Credit/Debit card payment

Expiry date

If you have any trouble with credit card payment, please do contact Tiffany.