Pregnancy Yoga Intake Form

If you are a brand new pregnancy yoga student, please complete this form prior to your first session. If you would prefer to fill out a physical copy of the form, please email hellofriendsyoga@gmail.com and we will provide one for you.

First name

Last name

Email

Phone

I'm excited you're joining the pregnancy yoga series. Please provide the following information so we can support you best during class.

Emergency Contact (Name and Phone Number)

Estimated Due Date

Day

Month

Year

Is this your first pregnancy?

Yes

No

What would you like to achieve from this course (check all that apply)?

If you selected "Other" please provide details here:

Is there anything that concerns you about the class or anything else that you would like me to know about before you begin the class?

By ticking this box, I take full responsibility for all applications of yoga I practice in the class and outside the class during my pregnancy. I understand that the recommendations, ideas or techniques expressed in the pregnancy yoga classes cannot be regarded as a substitute for the advice of a qualified medical practitioner. Any uses to which the recommendation, ideas and techniques are put at my sole discretion and risk.

I confirm that I have consulted my healthcare provider and am fit to attend a Pregnancy Yoga class.

I agree to let my teacher know if anything changes regarding my pregnancy and health after completing this form.

I agree to receive email communications about the class, course, or workshop I'm registering for.

I'd like to receive occasional emails about other Hello Friends Yoga offerings and information they think will be of interest to their students.

Please enter the date you agreed to the terms and submitted this form.

Day

Month

Year