Your Name
Your name is required.

Your Address
Your address is required.

Your Phone
Your phone number is required.Please enter a valid phone number.

Your Email
Your email address is required.Please enter a valid email address.

Your Occupation
Your occupation is required.

Your Date of Birth Your date of birth is required.

Emergency Contact A name is required.

Emergency Contact Phone A phone number is required.Please enter a valid phone number.

Have you ever previously done yoga?
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Please make a selection.
What is your reason for joining this dru yoga class? An answer is required.

What if any goals would you like to achieve from this Dru Yoga class? An answer is required.

General Health Survey

Do you have or have you ever suffered from any of the following?

Have you had any recent accidents or recent injuries? Please give details.
An answer yes or no is required plus any details if relevant.

Do you have any other medical conditions not covered in this form? Please give details.
An answer yes or no is required plus any details if relevant.

Consent

A Dru Yoga motto is "No Pain - No Pain" so with that in mind please read the following consent and check the box.

I understand that everyone has different physical abilities. As I participate in class I will move and stretch within my own bodies capabilities.

I take full resposibility for my actions in class both physically and spiritually and will not hold Guided Path Therapies liable for any injuries incurred during the Dru Yoga class.

I also understand that it is my responsibility to inform Guided Path Therapies if I become pregnant or have any of the above conditions in the future.

I have read the above and by checking this box do agree to the conditions as stated An acknowlegement is required to participate in yoga class.

I would like to receive by email information regarding Dru Yoga from time to time.

Yes No
Please make a selection.