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30 Day Yoga and Transformation Challenge
TESTIMONIALS
Home
Yoga
Prices
First Timers
Schedule
Juice Bar
Events and Community
Blog
30 Day Yoga and Transformation Challenge
TESTIMONIALS
Please Fill out the Form below.
All fields marked with * are required.
Name
*
Name
First Name
Last Name
Gender
*
Male
Female
Phone
*
Phone
(###)
###
####
Email Address
*
Date of birth
*
Date of birth
MM
DD
YYYY
Emergency Contact
*
Emergency Contact
(###)
###
####
Have you ever been diagnosed with a heart condition?
Yes
No
Do you feel chest pains at rest or during physical activity?
*
Yes
No
Have you ever been recommended to take only medically supervised exercise?
*
Yes
No
Have you ever been diagnosed with High blood pressure?
*
Yes
No
Do you ever lose consciousness or control of your balance due to dizziness?
*
Yes
No
Do you suffer from epilepsy?
*
Yes
No
Are you pregnant or have given birth recently?
*
Yes
No
Is there any other reason that exercise or activity may not be suitable for you?
*
Yes
No
Do you have any injuries?
*
Yes
No
Please provide further details if you answered "Yes" to any of the above questions.
*
How did you hear about Bikram Yoga Nairobi
*
Declaration and application
*
I have read and fully understand this form, including the Bikram Yoga Nairobi terms and Conditions overleaf. I confirm that to the best of my knowledge the answers given by me are correct. I know of no reason why I cannot participate in any form of physical exercise or any of the activities detailed in Bikram Yoga Nairobi website or suggested by an employee or representative of the business. I acknowledge that any such suggestions from any employee or representative regarding exercise, healthcare or nutrition are neither diagnostic or prescriptive. I agree to notify you of any changes to the above answers that may occur in the future before continuing to exercise. By signing this form I agree to the use of my information as stated in this form and i apply to be a member of Bikram Yoga Nairobi subject to Bikram Yoga Nairobi Terms and Conditions.
Yes I Agree
No I Disagree
Signature
Date
Date
MM
DD
YYYY
Thank you for your Registration. We will contact you shortly.