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).

Thanks for sharing your personal data. The information helps to make the classes safe, enjoyable and beneficial for all. 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 all regular weekly classes, except for my classes at Satyam Yoga studio.

Yoga and Qigong Class registration Stripe version
Address
Post Town/City
County
Postcode

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

PLEASE:

  • 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.

Declaration

  • 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.

Payment

Credit/Debit card payment

Credit Card number
Expiry date
CVC

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

shares