Which class are you interested inYoga for Mums & Tots Knutsford Tues 9.30-10.15Mum & Baby Yoga Knutsford Tues 11-12.00Yoga for Mums & Tots Mcr Thurs 10.15-11.00Mum & Baby Yoga Mcr Thurs 1-2pmOnline Mum & Baby YogaRestorative Evening Weds 20.15-21.45One to oneOther
Date and place you gave birth
Are you currently breast-feeding:YesNo
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?YesNo
Have you done Pregnancy Yoga before?YesNo
If yes, did it help you during labour?YesNo
What would you like to gain through post natal Yoga classes
Was this your first pregnancy?
If no, please give age of children
If yes, please give details
Do you currently experience any of the following. Tick any relevant symptomsTirednessSleep 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:YesNo
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.YesNo
Responsibility for my health - Online and In-personBy 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
Covid 19 - In-person classesBy ticking this box I declare that I have read, understood and agree to abide by Yoga with Maryline Covid-19 policy and any updates as advised (link in website footer) I confirm that I attend classes entirely at my own risk and I hereby release, waive, discharge YogaSpirits from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me (or my baby/ies) related to COVID-19 while participating in any Yoga with Maryline activity that may lead to unintentional exposure or harm due to COVID-19.
Photography and Video - In-person classesFrom 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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