Ella Williams Yoga - New Student Information

Before you come to class for the first time, it's very important that you complete this form so I can understand how best to help you during the class. The information you provide is completely confidential and won't be shared. I may get in touch with you to discuss some of the information before the class if appropriate.

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* 1. Today's date

Date / Time

Date

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* 2. Your Name

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* 3. Email address

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* 4. Phone Number

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* 5. What do you hope to gain from the class?

To feel calm/ relaxation

Stretching / improved flexibility / mobility

Improve mental state / reduce stress /anxiety

Improve sleep

To help cope with a particular ailment or situation

Exercise / general fitness

For improving breathing / techniques

Meditation

Improve strength

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* 6. What experience do you have of yoga?

None

A little

Some

Some but I haven't done it for a while

Lots

I've done something similar but little or no yoga

Quite a bit

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* 7. Is there any thing I need to know about your physical or mental health? If any of the following affect you, please check the box. If you check a box next to recent surgeries, treatment for diagnosed medical conditions, major injuries in the last 5 years, taking prescribed medication, I would need to discuss this with you before coming to a class. This information is required for your safety. Whilst yoga can be practised safely by most people there are some conditions which require special attention. If you are unsure, please consult your GP before attending. If you do not disclose any medical information you do so at your own risk.

Recent surgery

Major injury in the last 5 years

Taking prescribed medication

In treatment for a diagnosed medical condition

Unspecified back pain

Spinal injury

Joint replacement

Knee Problems

Hip problems

Shoulder problems

Neck problems

Heart disorders

High blood pressure

Low blood pressure

Arthritis

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* 8. Declaration. Please read carefully

I confirm the above info is correct and that I take responsibility for my own health & safety whilst in the class, whether in person or remote.

I understand it's my responsibility to check with my doctor if I have concerns about joining a class and inform my teacher.

I am happy to be contacted via email and understand that email is used to let me know if a class is cancelled and inform me of latest news.

I will check for any hazards around me and remain on screen while participating in any remote yoga session, and no liability will arise on the part of the teacher if I don't

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* 9. How did you find out about my classes? It's really useful to know!

Poster/flyer

From a friend

Internet search

Social media

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* 10. Please indicate if you have ever experienced any of the following:

Unusual shortness of breath with light exertion

Pain, pressure, heaviness or tightness in the chest area

Unexplained pain in the abdomen, shoulders or arms

Severe dizzy spells or episodes of fainting

Regular lower leg pain during walking that is relieved by rest

Palpitations or irregular heartbeats

I am currently pregnant or I have given birth in the last 6 months