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If YES, please provide further details (e.g. style, for how long, current practice)

Please provide any further information with regards to your health that I should know about.

Do you have any other medical conditions not covered above that might be adversely affected by yoga practice or are likely to cause you concern?

DECLARATION (Please read the following and sign below) I confirm that the above information is correct. I take full responsibility for my health during yoga classes I understand that it is my responsibility to: • Check with my GP beforehand if I have any concerns about my ability to practice yoga • Advise the teacher of any change in my medical information or other, which may be relevant before the start of each class. • Follow the advice given by my GP and yoga teacher but I understand that Poppy Sayers is a yoga teacher and not a medical professional of any type. • Take full responsibility for not exceeding my physical limitations and for any injury that might occur as a result. • Only do what feels comfortable in class and not to work in pain • To inform the teacher if I experience any difficulty in class • To practice mindfully and safely. I acknowledge that participation in yoga classes exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Poppy Sayers from any and all liability, negligence or other claims arising from or in any way connected with my participation in yoga classes in any location.

Please type your name and today's date below as your signature and acceptence of all above terms.

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