Health Information – Please read the following carefully and let me have brief details where appropriate.

If you

Ø                   have any serious medical condition (e.g. heart disease or circulatory disorders,

            back injuries, high/low blood   pressure, cancer, epilepsy, diabetes, detached retina, recovery from recent surgery)

Ø                   have any muscle or joint problems

Ø                   are currently taking any medication or are receiving any  medical treatment

Ø                   are pregnant

Ø                   have any other condition not mentioned above that may affect your yoga practice

I agree for my own safety and well being to inform the course leader prior to the yoga weekend

should any changes in the information given on this form occur, or if any medical, physical or

emotional problems should arise during the weekend.

Please sign below to show you have read and understood the above

Signed:                                                                   Date:

Please note – this information will be treated in the strictest confidence.