STUDENT QUESTIONNAIRE
Student Information
Emergency Contact Details
Yoga & Health Information
Medical Conditions (tick if applicable)
The following conditions required specific modification to your yoga practice. Please indicate below if you have any of the following medical conditions:
Please indicate if you ever experience any of the following symptoms:
IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE, I WILL CONTACT YOU FOR MORE DETAILS
Student Declaration
I confirm that I have answered all questions honestly and that the information given is correct.
Please inform your teacher if any of the above should change. Thank you.
If you are over 69 years of age and are not used to being very active, check with your doctor before you change your physical activity patterns.
