Dru Yoga Personal Info form – Dru Yoga Cape Town and Buteyko Instruction

Name

First Name

Surname

Phone

Email

Date of Birth

Next of kin/Emergency Contact

Next of kin Name

name

surname

Phone

Personal Health

The following information is treated as confidential. Please select from the below if you experience any of the conditions and provide details that may affect your ability to do yoga. Classes may be able to be tailor made to your needs. Should you not wish to share medical information please ensure you have checked safety practices with your health practitioner.

My general health is….

Excellent

Good

Manageable

Challenging

I experience / have experienced

I am pregnant

Yes

No

Other health issues

Breathing

I feel anxious when bringing attention to my breath

I struggle to take a deep breath

I struggle with the exhale

I believe that deep breathing is good for me

I suffer from rhinitis (blocked nose)

Please state any other breathing related issues

Classes are offered on a block payment system of 4 classes to be used within 6 weeks. This allows you to get the best out of the classes and keeps the classes consistent. Unfortunately all payments are final and I can not refund or transfer class passes or memberships, for any reason. Advance bookings for classes where payment is required can be cancelled up to 24 hours before the class, after this time refunds or transfers of credit will not be available.By making a booking with Dru Yoga Cape Town you take full responsibility for your own health and wellbeing during the class and when you practise anything taught in your yoga class. By submission of this form you acknowledge that you have read this disclaimer.

I have read the above