Women's Circle Registration Form

Please fill in and submit this form before your first session.

These sessions are open to all women, including those who are simply interested in boosting their overall well-being by reconnecting with their female power through Yoga and Qigong and those who have some particular health issue.

In either case, thanks for sharing your personal data - this information helps me to make the classes safe, enjoyable and beneficial for all. Please focus on the sections relevant to you 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 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 full Privacy Policy.

Womens Circle Registration Form

Personal Details


Yoga & Exercise

General Health and Medical Conditions

Reproductive Health

Medications etc


  • 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) to class.
  • Bring a large towel/light blanket to Yoga, if possible.
  • I have Yoga mats and other equipment, but feel free to bring your own mat if you would prefer.
  • 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.