Student Consultation Form - Wellbeing Winnie

This information will never be share with a third party. By signing this form you have understood the General Data Protection Regulation (GDPR) and agree that your information will be kept and used by members of WellbeingWinnie with regards to your interaction with the company. N.B if you have a condition that is being monitored by your doctor please check with him/her before continuing with the exercise programme, Please note that if you are attending a class or tutorial in person (not online) you will need to provide an emergency contact number in the same section as your own telephone number. Please inform us of any changes in your health that occur during this course. I understand the information I have provided to be correct to the best of my knowledge

Yes I have understoon

Name & Address

Phone Number

Emergency Contact name and number

D.O.B

Although yoga is suitable for all ages, you may feel you have certain age related restrictions. Our bodies experience certain biological changes through out our lives and we would like to ensure you are offered the best service just for you.

Please provide any additional information about your health that you think may impact your yoga practise

How much yoga and meditation experience do you have?

Please include any styles of yoga you are familiar with

Do you require the loan of a yoga mat

How do you feel about the use of music or essential oils during a class? Are there any essential oils that you are allergic to or dislike?

Please include any styles of yoga you are familiar with

Do you have any questions or concerns that you would like to share with us? Please also use this space to share any information that you think will be important?

I have read the terms and conditions (found on T&C's page)

Yes I have read and understood the terms and conditions

I confirm that all the information I have provided is (to the best of my knowledge) Accurate. This will be considered a digital signature and agreement. Please add name and date below

If you are human, leave this field blank.

Wellbeing Winnie - Yoga Student Consultation Form

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