Client Intake Form

Client Intake Form

Thank you for taking a moment to tell me more about yourself! This form helps me prepare the best program for you and your yogic journey. I can’t wait to meet you!

Name(required)

Age(required)

Email(required)

Phone(required)

Address (required)

Yoga Experience

Have you ever practiced yoga before? (required) Yes

No

If yes, how often do you practice yoga? Daily

Weekly

Monthly

How would you like to benefit from practicing Yoga?(required) Increase Flexibility

Increase Strength & Stamina

Stress Management

Spiritual Development

Find Body Love and Awareness

Injury Rehabilitation

What is your interest in learning meditation and breath work?(required) Reduce anxiety

Realize my true nature & purpose

Feel calm and centered

Improve health

Normalize blood pressure

Lifestyle & Health

Please mention any medical conditions or limitations you have, and if necessary furnish a letter from your physician authorizing Yoga or stating any exercise limitations:

Please read the following information and accept below.

I am so excited to welcome you as a yoga student at Elora Allen Yoga. The following information will help you get the most out of your yoga classes and clarify the instructor/student relationship.

I believe that Yoga is more than physical exercise. It is a transformative practice that integrates body, mind and spirit. This release of emotional tensions allows my students to arrive at deeper levels of relaxation and awareness. As with any physical activity there is a risk of injury associated with yoga.

The decision to perform any exercise is down to the individual, and the instructor (Elora) cannot accept responsibility for problems during or outside a class. The participant agrees to take on full responsibility for their actions within the class and shall work within their own limits. If students have any inquiries or health concerns it is their responsibility to notify Elora so that she is aware of the students limits. If you are in doubt as to your fitness, please consult your physician beforehand.

Elora shall not be held liable for any injury, loss or damage to property and/or persons sustained during or as a result of participation in this class. I agree to listen to my body and monitor myself during every class session. I agree to the Terms and Conditions as stipulated by Elora, including the cancellation policy.

(required) I accept the statement