Beach Organics Yoga Class Booking Form

Beach Organics
PO Box 104
Port Elliot SA 5212
Telephone 08 85542956

Yoga Class Booking Form

Please note ...

All equipment is supplied.
Please remember to wear appropriate comfortable gear.
We reserve the right to cancel a course if registrations are insufficient.


Your Name	:
Address	:

Town/City	:
State	:	Postcode:
Email	:
Daytime Phone	:
Evening Phone	:

Date of first class:

How did you hear about the classes?

Medical Details:		The information you give me may assist in providing a better service to you. Your answers will be kept strictly confidential.

		High Blood Pressure	Low Blood Pressure	Asthma
		Heart Problems	Epilepsy	Arthritis
		Back Problems	Joint Problems	Neck Problems

Are there any other injuries you need to consider?

If pregnant, how many weeks?

Please read this:		Your teacher will take all possible care to ensure your well-being, enjoyment and safety in class. However, it is your body and you know your strengths and limitations best. It must be your responsibility to not exceed your current abilities and inform your teacher if you are experiencing difficulties. *Please tick if you accept these conditions.*

PRIVACY POLICY: Beach Organics respects your privacy. We are committed to protecting your personal information. We only collect the personal information we need to provide our services to you. Your personal information such as your name, address and contact details) are not shared or provided to any other individual or organisation, and access to this information is restricted to Beach Organics only. This privacy statement is periodically reviewed in line with the ongoing development of the Beach Organics Website.