Gentle Yoga Rebellion CIC – Making Yoga & Yoga Therapy Accessible to All in North Cornwall

First name

Last name

HOME POSTCODE (This offer is only open to permanent Cornwall residents)

Phone

Date of Birth

Day

Month

Year

Which class would you like to attend?

Yoga & Somatics with Mara Blackburn St Eval Parish Hall Mondays 10-11.15am

Chair Based Hatha Yoga with Trish Onderdonck-Young Delabole Methodist Church Mondays 2.00-3.00pm

Mat Based Yoga with Nachelle Nightingale St Minver Community Hub Mondays 6.30-7.45pm THIS CLASS IS NOW FULL (Please choose this option & submit this form to be added to the waiting list).

Traditional Hatha Yoga with Trish Onderdonck-Young Delabole Methodist Church Mondays 7.15-8.30pm

When do you plan to attend your first session? Sessions may not run every week (e.g. holidays). If your chosen class isn’t scheduled, we’ll let you know. If your class is FULL, choose today's date and we'll let you know when a space opens up.

Day

Month

Year

Are you pregnant or have you been pregnant in the last 3 months? Due to the nature of this project, we cannot accommodate participants who are currently pregnant or less than 12 weeks postpartum.

Do you have any health conditions or injuries that we should be aware of to help ensure a safe and comfortable yoga experience?

Please detail any access or inclusion needs that we can support ?

Emergency Contact (Name & Relationship)

Emergency Contact Number

Disclaimer: Your answers to the above questions confirm that you understand that Yoga includes physical movement & breathwork and that not all practices are suitable for all people.

All participants are responsible for their own health & wellbeing.

If you are unsure whether or not it is appropriate for you to take part in this project, you ought to seek advice from a health care professional.

Can we use photos of you (no names) for our webpage & social media?

Can we use your comments and feedback on our webpage & social media (no names are required).

We would like to contact you very occasionally to tell you about our other projects etc. We will NEVER share your details with anyone else. If you would like us to keep you updated about our projects, how would you like us to contact you?

Phone

Please don't contact me about other projects