Your name

Date of Birth

Your email

Occupation

Gender
FemaleMale

Address(Please write the full address)

Contact Phone Number

Emergency Contact Name and Phone Number

Have you practiced Yoga before?
YesNo

If yes, which style of Yoga have you practiced?
Hata YogaVinyasa YogaYin YogaAshtanga YogaRestorative YogaOthers

For how long have you been practicing the above mentioned style of Yoga?

Why are you interested to be part of this Yoga Program?

Do you have any health issues or injuries?(The information will be confidential)
AnxietyArthiritisBack PainChronic PainDepressionDiabetesEpilepsyHeadachesHeart ConditionsHerniaHigh Blood PressureJoint PainLow Blood PressureMuscular PainsOsteoporosisPalpitationsChest Pain/Tightness in ChestPregnant or recent PregnancyRecent SurgerySpinal InjuryStrokeThyroid ConditionUlcerChronic Health ConditionPCOD/PCOSAny major injury in the pastAny recent injuryMIgraineJoint ReplacementAsthmaAny Hip related painIndigestionConstipationMenstrual issueAny Harmonal ImbalanceNothing as such to bring to your noticeOther

For any of the health conditions or injuries you have ticked above, please provide us further details. If it is not applicable then type 'NA'.

Please mention if there are any particular practices you are sensitive to and do not want to do it for any personal reason.

I accept the "Terms and Conditions" mentioned above and will abide to them throughout the Program.
Yes, I agree