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Please tick if you are interested in any of the following: *

Level 1 Mindfulness Coaching Level 2 Mindfulness Coaching Yoga & Mindfulness Teacher Training Long Slow Deep Master Class Beach Yoga Special Guest Tours Mums n Bubs Yoga Private Yoga on Location Other (please specify below)

Consent: I have been informed and understand that strength and flexibility exercises including Yoga are potentially hazardous activities. I also have been informed that these activities involve a risk of injury and that I am voluntarily participating in these activities with full knowledge and understanding of the dangers involved.

Please note if you answer YES to any of the following questions, please ensure you have approval from your GP and/or Health Care Practitioner to allow you to participate in any fitness related activities with e'yoga.

Do you have any muscle, bone or joint problems that could be made worse through physical activity? If yes please provide details below *

Yes No

Do you lose your balance because of dizziness or do you ever lose consciousness? If yes please provide details below *

Yes No

Do you feel pain in your chest when you exercise or have a history of chest pain in the last month? If yes please provide details below *

Yes No

Have you ever been diagnosed or are you concerned about a mental health condition? * If yes, please provide details *

Yes No

I declare that I consent to use the health and fitness programs offered by e'yoga.

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Direct debit into ACN:12-3095-0029175-01
* Any deferred payment options must be approved - please email e'yoga .

Please Select & See Banking Reference Details For Events *

5 Class Pass - 5CP Private YOGA LSD Master Class with Kelly - LSD Introduction to Mindfulness - INTR02602 Master Class with Tammy - MAST2602 Master Class - Introduction to Mindfulness - COMBO2602 Level 1 Mindfulness Coaching - LVL10216

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