Student enrolment form

Name *

First

Last

Address and postcode *

Date of Birth

Contact Number *

Email *

Emergency Contact Details *

Please enter the name, surname and contact number for your emergency contact.

Please select below the class (or classes) you wish to enrol on *

Medical History: Please note any medical history, including present or past medical condition(s) that your teacher should be aware of, e.g. pregnancy, recent operations, joint problems, high/low blood pressure, heart problems, strokes, cancer, epilepsy, diabetes, detached retina, asthma, depression, allergies, etc. Details of any current medication(s) should all be included.*

*It is important to discuss with your teacher any condition that might affect your yoga practice. Your teacher cannot be held responsible for problems arising from conditions which have not been disclosed. The above information will be kept confidential and secure in accordance with the General Data Protection Regulations 2018. It is required to ensure your own safety and to enable you to benefit fully from your yoga class.

Student declaration - please tick if you give your consent *

I give my consent for my personal data to be kept at the Knutsford Iyengar Yoga Centre

Newsletter preference

I wish to receive newsletters, by email, from the Knutsford Iyengar Yoga Centre

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