Yoga and Meditation Registration Form

We care about you. The information you provide here enables us to understand your (or your teenager's, if completing on their behalf) health, any illness or injuries and your yoga/meditation experience, so that we can give you/them our highest level of service, care and safety.  

You will be required to create a password so that you can log-in to our website and change/update any of your details at a later date. Please note that a different email address is required for each person who registers.   

Your information is secure and remains confidential. A copy of our Privacy Policy is available upon request. Please fill in the form as fully as possible. You can write as much as you need to for the open-ended questions, as the boxes expand to fit the amount of text. Thank you. 

 * Required

(If registering your teenager, include their first name first, then yours eg. Tom and Cheryl)


 








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Yes, please subscribe me Momentum's Newsletter List. We would love to stay connected! We provide a monthly e-newsletter to our contacts. It's a good read, with plenty of tips, information and inspiration. And you can unsubscribe at any time.

9. Declaration & Acceptance of Terms

Yoga and meditation is founded on the development of self-awareness, including for each individual student, an awareness of their own physical and mental capacilities, and the rate at which those limitations can be gradually overcome through practice.

It is essential that students retain full responsibility for their own physical and mental well-being in applying instructions in the practice of yoga and/or meditation to their own circumstances, both during and outside classes. Momentum Coaching & Yoga provides instructions to students in the practice of yoga and meditation strictly on that basis.

Momentum Coaching & Yoga will not accept liability for any injury or loss suffered by students in their practice, whether during or outside of classes.

In registering with Momentum Coaching & Yoga, I declare that the above information is true and correct. I accept responsibility for informing Momentum Coaching & Yoga about any medical conditions, injuries, pregnancy or changes to my/my teenager's health that may affect my/their yoga or meditation practice, prior to a class commencing. I understand that I/they participate in yoga and meditation at my/their own risk and accept responsibility for any loss or injury suffered.

I confirm my acceptance of these terms - please check the box. 
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