Poppy Sayers Studio Questoinnaire and Terms of Use Question Title * 1. Name Question Title * 2. Email address Question Title * 3. Mobile Number Question Title * 4. Age Group Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 5. Have you done yoga before? Yes No Question Title * 6. If YES, please provide further details (e.g. style, for how long, current practice) Question Title * 7. What is your main reason for coming to yoga sessions? Exercise Relaxation Stress relief Flexibility Pain relief Meditation Spiritual Other (please specify) Question Title * 8. The following information is required to ensure your safety. Whilst yoga may be practiced by the majority of people, there are certain conditions which require special attention. If you are unsure, please consult and seek permission from your GP before commencing yoga.The following conditions may effect your yoga practice. Please tick if any of the following apply to you. If you tick any, please provide further details below. Abdominal disorders Arthritis (osteo / rheumatoid) Back pain/problems Heart conditions / disorders High blood pressure Hip problems Low blood pressure/fainting Knee problems Nerve damage / trauma Osteoporosis Pain, stiffness swelling Pregnancy / recent pregnancies Broken bones Surgery (in the last two years) Shoulder / neck problems Auto-immune disorders (e.g. ME, MS) Anxiety / stress / depression Balance affecting disorder (e.g. vertigo Diabetes Epilepsy Sensory disorders affecting eyes / ears Respiratory problems (e.g. asthma) Other Please provide further information None of the above Question Title * 9. Do you have any other medical conditions not covered above that might be adversely affected by yoga practice or are likely to cause you concern? Question Title * 10. DECLARATION(Please read the following and sign below)I confirm that the above information is correct.I take full responsibility for my health during yoga classesI understand that it is my responsibility to:• Check with my GP beforehand if I have any concerns about my ability to practice yoga• Advise the teacher of any change in my medical information or other, which may be relevant before the start of each class.• Follow the advice given by my GP and yoga teacher but I understand that Poppy Sayers is a yoga teacher and not a medical professional of any type. • Take full responsibility for not exceeding my physical limitations and for any injury that might occur as a result.• Only do what feels comfortable in class and not to work in pain• To inform the teacher if I experience any difficulty in class• To practice mindfully and safely.I 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 Poppy Sayers from any and all liability, negligence or other claims arising from or in any way connected with my participation in yoga classes in any location. Yes No Please type your name and today's date below as your signature and acceptence of all above terms. Done