APPLICATION FORM – HOLISTIC AND INTEGRATED YOGA CLASSES
Form No: …………………
HOW DID YOU HEAR ABOUT US?
Just Dial Website Friend/ Relative Google
Face Book SMS/Email Pamphlets Sign Board
Walk – In Others ……………………………………
Full Name: ……………………………………………………………………………………
Date of Birth: ………………………………….. Gender: Male Female Age...............
Email: ………………………………………………. Contact Number: ……………………..
Mobile: …………………………………………….. Blood Group: …………………
Address:…………………………………………………………………………………………………
……………………………………………………………………………………………………..........
Locality: ………………………………….. Pin Code: ………………………..
City: ……………………………………………
Country: ……………………………………… Nationality: ……………………………….
Occupation: ………………………………………………
Company: ………………………………………………………………………………………
Which program would you like to opt for?
Daily Yoga Class Anti-Gravity Fitness Class Pranayama & Meditation Class
Combo: …………………………………………………………………………..
How many months would you like to go for?
1 Month 3 Months 6 Months 12 Months
Preferred Class Timings: …………………………………………………………………..
Do you have any prior Yoga experience or do you follow any other fitness routine?
…………………………………………………………………………………………………..
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If yes, how long have you been practicing yoga or any other fitness routine?
……………………………………………………………………………………………………………
Alternate Contact Details:
Name: …………………………………………. Relation: ……………………………..
Contact No: ……………………………………..
Yoga Asanas involve physical stretching. In the interests of your own health, it is important for us to
know your medical history and decide if you should refrain from performing some yoga asanas.
Do you have any medical condition / injury?
Details: …………………………………………………………………………………………
Have you had any pervious history of injuries to your back / ankles / knees / neck /
shoulders or any bones / joints?
Details: …………………………………………………………………………………………
Have you been advised by any doctor not to perform (or refrain from) any form of physical
exercise?
If yes, please share details: …………………………………………………………………….
Disclaimer and Signature
I hereby declare that I am signing up for Sri Krishna Wellness Yoga and Cultural Centre – Holistic
and Integrated Yoga Classes on my own accord. I undertake that I will exercise all precautions
advised by instructors during the yoga course and I will not hold the instructors of Sri Krishna
Wellness Yoga and Cultural Centre legally responsible for any liabilities or damages should I be
injured during the course of practicing Yoga.
Signature of Applicant
Date:
- For office Use –
Date of Joining ………………………………………………. Renewal Date: ………………………………………………….
Mode of Payment:……………………………………………… Amount:……………………………………………………………
Signature of Receiver: Date:
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