Post natal yoga registration

Which class are you interested in






Date and place you gave birth

Boy/girl/twins name(s)

Are you currently breast-feeding:

Have you undergone: epidural/c-section/natural birth/water birth

List any particular conditions which may have affected your pregnancy or labour eg SPD/diabetes

Baby came late, low placenta etc

Have you done Yoga before?

What style?

Have you done Pregnancy Yoga before?

If yes, did it help you during labour?


What would you like to gain through post natal Yoga classes

Was this your first pregnancy?

If no, please give age of children

Previous difficulties/miscarriages?

If yes, please give details

Do you currently experience any of the following. Tick any relevant symptoms
TirednessSleep disturbancesSPDConstipationAnxiety / DepressionAching groinsAnaemiaDiabetesPilesLower Back PainSciaticaLow Blood PressureVaricose VeinsOedema (swollen joints)Diastasis rectiHigh Blood Pressure

Please give details of any other health issues you may encounter:

Last, have you suffered any injury or undergone any surgery (i.e. knee surgery) which could affect you Yoga practice? If so, please give details, thank you

Do you have any allergies or dietary requirements:

If yes, what kind

How did you hear about the class?

Would you like to keep in touch with Marylines news of classes, workshops, audio and video material. If yes, we'll add you to our mailing list. Your details won't be shared with anyone else.

Responsibility for my health - Online and In-person
By ticking this box I declare that as far as I am aware, I have disclosed to Yoga with Maryline all information regarding my health (and the health of my baby/ies) relevant to the practice of yoga and/or meditation. I take full responsibility over the health of myself (and my baby/ies) in the yoga sessions (face-to-face or online) and for all applications of yoga I may practice outside the classes both now and in the future. I understand that any uses to which the recommendations, ideas and techniques are put are at my sole discretion and risk. Should there be any medical changes I will consult my doctor and inform Maryline as my yoga teacher

Photography and Video - In-person classes
From time to time photographs and video footage of classes may be taken for use in my marketing. No compensation or fee may be claimed for this usage, and permission is always asked at the time.
Yes by ticking this box I consent to photos of myself (and where applicable my baby) being used in films and photographs in any and all media, now or at any time in the future.No by ticking this box I do not consent to photos of myself (and where applicable my baby) being used in films and photographs in any and all media, now or at any time in the future

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