Prenatal Yoga Registration Complete the information below and press the Register button at the bottom of the form. Required fields have a red asterisk after them. First Name * Last Name * Address * City * Province * Postal Code * Evening phone # * Email * Please list any physical condition that might limit your participation in a yoga practice other than being pregnant. Physical Conditions Please list the goals that you want to achieve with yoga. Your goals How did you find us * ...websitespotlightbuilding signreferralother What was your search term Who referred you Other Pregnant section Due Date (mm/dd/yy) * High Risk A doctor's note is required if you answer YES to any of the following: Are you over 35 years of age? Do you have a history of miscarriages? Are you new to exercise and yoga? Is this a high risk pregnancy? Do you have low blood pressure or a history of fainting? Are you high risk * Yes No If you have any questions, please enter them below and I will do my best to answer them. Your questions What is 5 x 3 * Participation Agreement Yoga is an educational program that involves exercise. Each student is responsible for their own health, safety and well being while participating. Students hereby agree to inform the instructors of any activity that cannot be safely performed and will not perform any activity that is likely to cause injury. The student agrees to hold the instructors free from any and all responsibility for any injury that may be sustained during or as a result of a yoga class. If you agree tick the box below. I agree *
