Health Declaration

Please fill out the following form in order to participate in my yoga classes.

All information remains confidential

(see GDPR policy for further details on how your data is stored- this can be found on GDPR page of the website here)

YOUR HEALTH /CONTACT DETAILS

First Name

Last Name

Date of Birth

Are you suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please inform me of any health problems (i.e asthma, heart problems, osteoarthritis, vertigo, or other health related issues)

Are you pregnant or post partum?

Yes

How did you hear about my classes?

HEALTH WAIVER

I declare that the information provided is accurate & complete and I waive and release Ruth Murray, Energise Yoga from any injury, or damages, to person or property, resulting from the taking part in any online or face to face yoga classes. Please ensure you inform me of any changes to your health following submission of this form. Practice at your own pace and listen to your body during classes.