World Family Yoga

Contact information
Name * First Last
Age *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone *
Work Phone
Email *
Do you wish to receive the World Family Yoga email newsletter (about 5 times per year) ?
Yes No (or already a subscriber)
Children
Will you be needing a babysitter?
Yes No
Child #1 First Last
Age of child #1
Child #2 First Last
Age of child #2
Child #3 First Last
Age of child #3
Child #4 First Last
Age of child #4
Dietary restrictions or food preferences for any children?
Do your children have any previous yoga experience?
Do the children have any physical limitations we should know about?
Your yoga experience and health
Do you have previous yoga experience? If so, how long and what styles? *
How often do you practice yoga/take classes? *
Will you be attending yoga classes on the retreat? *
Yes No
Do you have any current injuries, health conditions or chronic pain that may affect your comfort or participation during yoga classes? If yes, please explain.
Please check any conditions that apply
Diabetes Asthma Herniated/bulging disc Arthritis Hernia Hypertension Heart disease Spondylolisthesis/lysis Hypoglycemia Ulcers Epilepsy Sciatica High blood pressure Osteoarthritis Low blood pressure Allergies (food/meds) Chronic headaches Rheumatoid Scoliosis Digestive disorders Immune disorder Mental illness
Any other health conditions or surgeries you have had that may affect your retreat?
Do you have any food allergies or special diet considerations we need to accomodate?
Please list 2 emergency contact people
First contact : Name * First Last
Relationship *
Phone *
Alternate phone number
Second contact: Name * First Last
Relationship *
Phone *
Alternate phone number
Thank you! After sending this form, you will have the opportunity to register each additional adult. Trouble registering? Call Peggy in California (707)826-0239 or email peggy@worldfamilyyoga.com

After clicking the final button, you will receive an automatic confirmation email. We will also call you before sending an invoice payable with credit card or PayPal, or you can mail a check. A copy of the terms and waiver that preceded this form will be mailed to you, to be signed and returned.
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World Family Yoga

Contact information

Children

Your yoga experience and health

Please list 2 emergency contact people

Thank you! After sending this form, you will have the opportunity to register each additional adult. Trouble registering? Call Peggy in California (707)826-0239 or email peggy@worldfamilyyoga.com