Course Registration - Dhyanasth Yoga

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Welcome to Dhyanasth Yoga. This form is intended to gather essential client information to ensure a personalized, safe, and effective yoga practice. All data shared will be treated with strict confidentiality and used solely for therapeutic and instructional purposes.

Full Name

Date Of Birth

Age

Gender

Mobile Number

Emergency Contact Name

Emergency Contact Number

Residential Address

Preferred Mode of Participation

Occupation

Typical Working Hours per Day

Nature of Work

Do you currently engage in physical activity or exercise?

If yes, please specify the type and frequency

Kindly indicate if you have experienced or are currently experiencing any of the following conditions

If any of the above apply, please provide further details

Are you currently under any medical treatment or medication?

If yes, kindly list medications being taken

Do you have any known allergies?

Have you practiced yoga before?

If yes, please indicate duration and style(s) practiced

Any discomfort or limitations experienced in previous practice?

Primary reasons for enrolling in yoga classes

Please describe your expectations and personal goals with Dhyanasth Yoga

Declaration of Consent

I hereby declare that the information provided above is true and complete to the best of my knowledge. I acknowledge that yoga is a complementary practice and that I am responsible for informing the instructors of any changes in my health condition. I understand that while every effort is made to ensure safety, I participate at my own risk and discretion.

I have read, understood, and agree to the above declaration.

Digital Signature / Full Name

Date

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Address

Contact

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