REGISTRATION Step 1 of 5 - User Information 20% Type Of YogaWhat type of yoga are you interested in being a part of?* Hatha Yoga Pregnancy Yoga Baby & Me Yoga Kids Yoga Teen Yoga HiddenWhat type of yoga are you interested in being a part of? Hatha Yoga Pregnancy Yoga Baby & Me Yoga Kids Yoga Teen Yoga User InformationName* First Last Parent/Carer Name* First Last Username* Password* Enter Password Confirm Password Email* Contact Number*Date Of Birth* DD slash MM slash YYYY AddressFirst Line* County City* County Post Code* CAPTCHA Is the Emergency Contact information the same as Parent/Carer given previously?* Yes No Emergency Parent/Carer Contact Name:* Emergency Contact Relationship:* Emergency Contact Telephone Number:* Emergency Contact Name:* Emergency Contact Relationship:* Emergency Contact Telephone Number:*Can I add you to my GDPR* compliant list?* Yes No What is your main reason for bringing your child/teen to Yoga and what do you hope to gain from it?*Have You Practiced Yoga Before?* Yes No If Yes, what type and for how long?* What aspects of yoga interest you?* Physical Postures (Asanas) Breath Work (Pranayama) Meditation Relaxation Other Please Specify Kids and Teens YogaHow Many Children Are Attending Kids/Teen Yoga?* 1 2 3 First Child's Name?* Second Child's Name?* Third Child's Name?* First Child's DOB* MM slash DD slash YYYY Second Child's DOB* MM slash DD slash YYYY Third Child's DOB* MM slash DD slash YYYY First Child's School* Second Child's School* Third Child's School* First Child Allergies* Second Child Allergies* Third Child Allergies* First Child Health Issues / Medication* Second Child Health Issues / Medication* Third Child Health Issues / Medication* Are their any cultural factors needing to be considered?*Has your child/teen suffered any injury or undergone any surgery that may affect their yoga practice?* Yes No Please specify:*How did you hear about the class?Any additional comments?BabyBabies Name?* Babies DOB:* MM slash DD slash YYYY Did your baby arrive:* Full Term Premature Over Due Delivery:* Vaginal Medical Intervention C-Section Previous Births* Yes No If Yes, how many?*Separation of abdominal muscles (diastasis recti)* Yes No Please Specify:*Pelvic Instability?* Yes No Please Specify:*Pubic Pain?* Yes No Please Specify:*Back or Neck Pain?* Yes No Please Specify:*High/Low Blood Pressure?* Yes No Please Specify:*Prolonged Bleeding?* Yes No Please Specify:*Anaemia?* Yes No Please Specify:*Constipation?* Yes No Please Specify:*Varicose Veins?* Yes No Please Specify:*Fluid Retention?* Yes No Please Specify:*Sciatica?* Yes No Please Specify:*Exhaustion?* Yes No Please Specify:*Other? (Please List)* Yes No Please Specify:*Does your baby have any medical conditions?* Yes No Please Specify:*Any allergies?* Yes No Please Specify:*Do you take any regular medication?* Yes No Please Specify:*Have you had any significant medical conditions, injuries or operations (including c-section)?* Yes No Please Specify:*Pregnancy YogaIs this your first pregnancy?* Yes No How many weeks pregnant are you?* Due Date* MM slash DD slash YYYY Planned place of birth?* High Blood pressure?* Yes No Please Specify:*Low Blood pressure?* Yes No Please Specify:*Headaches?* Yes No Please Specify:*Dizziness Or Fainting?* Yes No Please Specify:*Pre-eclampsia?* Yes No Please Specify:*Diabetes* Yes No Please Specify:*Oedema? (Swollen Limbs)* Yes No Please Specify:*Pubic Or Pelvic Pain?* Yes No Please Specify:*Have you undergone IVF Treatment?* Yes No Please Specify:*Any Allergies?* Yes No Please Specify:*Do you take regular medication?* Yes No Please Specify:*Have you had any significant medical conditions or operations (including cesarean sections)?* Yes No Please Specify:*Have you had any injuries either past or present?* Yes No Please Specify:*Have you ever had a miscarriage?* Yes No Please Specify:*Hatha/Gentle YogaBack Ache or Pain?* Yes No Please Specify:High Blood Pressure?* Yes No Please Specify:Low Blood Pressure?* Yes No Please Specify:Diabetes?* Yes No Please Specify:*Arthritis?* Yes No Please Specify:Epilepsy?* Yes No Please Specify:Heart Problems?* Yes No Please Specify:Asthma?* Yes No Please Specify:Depression?* Yes No Please Specify:Detached Retina / Other Eye Problems?* Yes No Please Specify:Recent Operations?* Yes No Please Specify:Recent Fractures Sprains?* Yes No Please Specify:Knee Problems?* Yes No Please Specify:Neck Problems?* Yes No Please Specify:Recent Pregnancies?* Yes No Please Specify:Are You Pregnant?* Yes No Please Specify:I assume full responsibility for my health during the Baby & Me Postnatal class, including any risk, injuries or damages, known or unknown, which might incur as a result of participating in the class:* I do I take accountability for alerting the teacher of any medical changes, injury or impalement in advance before the class starts:* I do
