Yoga & Sound Bath Intake Form

Name *

First Name

Last Name

Phone

(###)

###

####

Date of Birth *

MM

DD

YYYY

Have You practised yoga before? *

Yes

No

Have you attended a sound healing before? *

Yes

No

Are you currently pregnant? *

Yes

No

I am okay with photography & video for marketing and social media use *

Yes

No

I agree to respect and honour yoga etiquette required, including leaving my smart phone and watch turned off for the practise, to give myself and the instructor full focus for the best session outcomes *

Agree

I agree to take what I need from the session & leave behind what I don't *

Agree

I agree to listen to my body and inform the instructor if something becomes uncomfortable or painful for me *

Agree

I understand that Yoga, Energy & sound healing is not a substitute for medical attention, examination, diagnosis, or treatment. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before the session. *

Agree

I accept that neither the instructor, nor the hosting facility, is liable for any injury or damages to person or property, resulting from participating in the session. *

Agree