Acroyogi Registration

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Date *

Full Name *

Date of Birth *

Email Address *

Phone Number *

Home Address

Post Code *

Gender

What is your experience of Acroyoga so far? *

Anything goes - have you been to a few jams or been studying to become a teacher yourself? There are no wrong answers! Just be open and honest so we can pitch the workshop at the right level for you <3

What are you keen to learn at this workshop ?

What is the Name and date of the Acroyoga Workshop you are booking onto? *

Have you ever practiced meditation?

Yes - I meditate daily

Yes - i meditate every so often

Yes - i did it once or twice

No - i have never experienced meditation

Clear selection

Tell us about your experience of meditation or what you think of it?

How do you want to deepen your practice?

Are you coming alone or with a partner? and if so who?

we can make sure you get to work together this way

Are you a base, flyer or both?

Mainly Base / Tree

Mainly Flyer / Elf

I rock it both ways! / I am a trelf!

Clear selection

Injuries/ Health History *

Do you have any injuries that are currently affecting you?

Do you have high or low blood pressure?

Yes

Clear selection

Has your doctor said you have any cardiac issues?

Yes

Clear selection

Have you been pregnant in the last 6 months or could you be pregnant now?

Yes

N/A

Clear selection

Please mark the relevant box/es if you suffer from any of the following or any of the following apply to you:

If none apply, tick 'other' and write 'none'

Frequent headaches

Dizziness or blackouts

High blood pressure

Low blood pressure

Asthma

Diabetes

Epilepsy

Back or neck pain

Arthritic joints, osteoporosis, osteopenia or any bone or joint problem that can be made worse by exercising

Pain in hips

Pain in ankles

Pain in wrists

Pain in knees

Pain in shoulders

Hyper-mobility (excessive joint mobility)

NONE

Other:

Are there any movements that cause you pain? If so please specify. *

If you have had major surgery in the past 10 years please specify.

Are you currently taking any drugs or medication?

Yes

Clear selection

Emotional Awareness

Are there any emotional issues that should be mentioned that may be relevant or that you want to address?

Your Responsibilities towards Nine Lives Yoga *

Please advise your Nine Lives Yoga teacher before commencing any sessions if, for any reason, your health or ability to exercise changes. It is inadvisable to do yoga between weeks 8-14 of pregnancy unless by special arrangement with your teacher. It is also wise to wait until 6 weeks after the birth before resuming exercise. Yoga exercises are very safe but as with all forms of physical exercise, it is prudent to consult your doctor before starting sessions if there is any doubt about your health and suitability to practice. These sessions are not a substitute for medical counselling or treatment. If you have any doubts about suitability of the exercises, you should refer back to your medical practitioner. The teacher can accept no liability for personal injury related to participation in a session and you hereby accept all responsibility for your body. Exercise should be performed at a pace that is comfortable for you. PAIN is the body’s warning system and SHOULD NOT BE IGNORED. Please inform your teacher immediately if you feel any discomfort after a previous session so we can adapt your programme accordingly.

Please tick this box to confirm that you have read, understood and agree to the terms above.

Required

Cancellations and Rescheduling *

For this Acroyoga workshop in Umeå on April 8th and 9th 2017 and Zurich in on the 14-16th April 2017 there is no cancellation policy. Once you book there are no refunds. If you need to change the name on your ticket we will accept resales with no problem, just ensure that both yourself and the person taking your ticket are copied into correspondence and both confirm this change via email 48 hours prior to the event.

Please tick this box to confirm that you have read, understood and agree to the terms above.

Required

Consent and Agreement *

I confirm that I have read and understood all of the above advice and that the information I have given is correct. I understand that yoga exercises involve hands-on correction and hereby consent for my teacher to work in this way as appropriate.

Required

That's it - Thanks!

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