Full Name (required)
Gender (required) FemaleMale
Nationality
Identification Number (required) Singapore NRICSingapore FINPassport
Birth Date (required)
Height - choose your preferred unit CentimetersInches
Weight - choose your preferred unit KilogramsPounds
Your Mobile Phone Number (required)
Your Email (required)
Your Address - Line 1 (required)
Your Address - Line 2 (required)
Suburb
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State & Country (If not in Singapore)
Postcode (required)
Relationship (required)
Phone Number (required)
To enable YogaTime instructors to understand your yoga capabilities better, so that we can try to make your YogaTime experience more fulfilling, we require you to share your experience with yoga.
Have you studied, trained or practiced yoga before? YesNo
Specify Yoga Type (required)
Specify Duration (required)
MonthsYears
Other Current Sports or Physical Activities (required)
What would you like to get out of yoga classes?
To promote the safety and benefit of your participation in YogaTime sessions, it is important that you fully disclose your personal health history, any medications you are taking and any treatments or therapies that you might be undergoing.
Are you currently on any long-term medication? (required)
YesNo
Kindly state the reason as to why you are on long-term medication
Do you have any medical conditions? Eg. Sinusitis/Migraines/High or Low Blood Pressure/Asthma/Arthritis/Lupus, Heart Disease, Cancer / Benign Tumours, Epilepsy, Diabetes, Multiple Sclerosis (MS), Glaucoma, Vertigo, etc. YesNo
Do you have any history of allergies? YesNo
Do you have any history of surgeries? YesNo
Do you have any history of injuries? Eg. Fractures/Breaks/Dislocations/Sprains/Twists/Contusions/Muscle Pulls/Tears, etc. YesNo
Do you have any history of Back Pain? Eg. Lower Back Ache/Sciatica/Slipped Disc, etc. YesNo
Do you have any history of Pain or limited joint movement? Eg. Arthritis, Rheumatism, Fibromyalgia, Tinnitus, etc. YesNo
It is the responsibility of the student to inform the YogaTime teacher or instructor if he or she is receiving treatment from a medical practitioner, has recently had surgery or a serious accident or illness, or is on medication. The student must check with the teacher within reasonable time on whether the specific class the student is interested in attending is suitable for his or her condition.
Are you / is there a possibility you might be pregnant?YesNo
Have you had a baby in the past 12 months?YesNo
Please be advised that should you become pregnant, you must inform YogaTime before participating in any of our activities. Also, certain poses will be unsuitable during ladies’ monthly periods. Please let the teacher know before class begins if you are menstruating
I declare that the above information provided to YogaTime is true and accurate. I agree that the instructor(s) and the owner(s) of my exercise premises shall not be liable for any claims during and or after, the lessons.
Due to the extreme care and caution exercised by the instructor, I shall not claim damages against the instructor should such injuries or losses occur.
This waiver and release of liability includes, without limitations, all injuries which may occur as a result of;
a) Your use of all amenities and equipment at your exercise location(s) in any activity, class, program, personal training, supervision, or instruction, b) The sudden and unforeseen malfunctioning of any equipment c) Instructor’s instruction, training, supervision, or dietary recommendations and d) Your slipping and/or falling at your training location(s)
You acknowledge that you have carefully read this “waiver and release” and fully understand that it is release of liability. You expressly agree to release and discharge your trainer/instructor(s) from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against your trainer/instructor(s) for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence.
If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from.
By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.
I agree and consent to the use of any photos and, or videos taken of me during class may be used for marketing purposes only.
Sign immediately below this line: [signature* signature-release cols:500]
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