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Yoga Consent Form
Please read the Terms & Conditions below before completing your consent form.
Terms & Conditions
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Date of Birth
Mobile Phone Number
If you are participating in an online course will you be doing the classes live or via recording?
Mix of Live & Recording
N/A - Private session
N/A - Attending Workshop in person
Have you attended a 'Yoga of Stillness' or 'Esoteric Yoga' class/course before?
More than once
Do you currently have any restrictions with your movement?
Please list any current & past medical conditions | injuries | operations
Please list any significant mental health issues past or current
Are you taking any prescribed medication and if so what is it for?
Are you pregnant? If so how many weeks?
In case of an emergency who should I contact? (Please list Name | Relationship | Contact number)
How did you hear about these classes | my services?
I agree to the terms and conditions listed for the Esoteric Yoga sessions presented by Marika Cominos
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2015 unless otherwise stated
Based in Melbourne, Australia
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