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* 1. Personal Details

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* 2. Date of birth

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* 3. Have you done yoga before?

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* 4. What type of yoga have you done before?

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* 5. What other exercise do you regularly do?

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* 6. Medical History: have you ever suffered from

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* 7. Reasons for starting yoga

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* 8. Self Responsibility Statement: I have read and fully understand that fitness activities involve a risk of injury and I confirm that I am voluntarily participating in these activities and using equipment with the knowledge of the potential dangers involved. I hereby agree to assume and accept all such risks of injury. I confirm that I have either had a physical examination and have my doctor's permission to participate or I am participating without the approval of my doctor and do hereby assume all responsibility for the consequences of my participation. I will act with due care to safeguard my own safety and that of fellow students. I will inform my yoga teacher of any changes in my medical condition that may have occurred, including injuries, prior to each class.

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* 9. All information is kept confidential and only used by Jenn Carpenter for your Personal Yoga Practice. Please confirm the details of this questionnaire by adding your name and today's date.  Thank you

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