Marulamala Students

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Marulamala Students

Student Registration Form

This is a confidential form with your personal information that will help enhance your class experience and help your teacher assess your needs and what is appropriate for you according to your health and fitness.

It is also a legal requirement and a pre requisite to being accepted as a student. All the information on this form will be kept confidential between you the participant and Marulamala Yoga.

Thank you for taking the time to fill out the details correctly. Please also sign where indicated at the end.

Marulamala Student Registration Form

Name

Date of Birth 'YYYY-MM-DD'

Address

Phone

Emergency Contact Name

Emergency Contact Phone

Your Occupation

Have you done yoga before? YesNo

If so, when was the last time you went to yoga?

What style or tradition of yoga have you practiced?

Do you have any previous injuries or pain in the following? BackNeckLegsArmsShouldersHips

Please briefly describe any injuries:

Are you under the care of a health professional? (eg. Doctor, Physio, Chiropractor, Naturopath, other)DoctorPhysioChiropractorNaturopathOther

Do you have any current medical conditions? DiabetesAnaphylaxisStrokeHigh/Low Blood PressureVertigoAllergiesAsthmaRespiratory (other)Seizures/EpilepsySleep ProblemsHeart ConditionsEmotional/Mental State (Depression, Anxiety)Digestive SystemOther?

If so, please briefly describe:

Are you on any medication? YesNo

If so, what medication?

Have you had any surgery in the last 12 months? YesNo

If yes, please briefly describe:

NOTE: It is your responsibility inform Marulamala Yoga of any medical conditions or physical problems which may restrict your practice. Please always make your teacher aware if you are suffering from any particular physical or emotional problems in order that he/she can take account of this during class.

Are you pregnant? YesNo

Please Note: If you are pregnant or think you may be, it is NOT advisable to participate in a general yoga class in the first trimester of pregnancy. Please request our Yoga and Pregnancy Advice Sheet.
SHOULD YOU HAVE ANY CONCERNS WHETHER OR NOT YOU ARE ABLE TO PARTICIPATE IN A CLASS PLEASE CONSULT YOUR HEALTH PROFESSIONAL PRIOR TO COMMENCEMENT

Release and Indemnity
As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. By signing below I acknowledge I understand that in yoga class I will progress at my own pace and if I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the Teacher. I will continue to breathe smoothly and If at any point I feel over exertion or fatigue, I will respect my body’s limitations and I will rest before continuing yoga practice.
Marulamala Yoga cannot be held responsible for ANY personal injury sustained during a class. Please choose a class that best suits your ability. This way your practice will flourish and you will receive the full benefits of yoga.
I therefore fully acknowledge that participation in yoga classes exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Marulamala Yoga and its Teachers from any and all liability, negligence or other claims arising from or in any way connected with my participation in yoga class.

Thank you for taking time to fill out this form today. Please check to make sure this information is correct.

Please tick the following box to confirm that you are have read and acknowledge these terms