A Quiet Place Yoga and More
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    • Bending toward justice
    • March 23 2020
New Student Questionnaire

NAME                                PHONE
ADDRESS (include zip)                        email:

Date of Birth                                 
How did you hear about this yoga class?

Have you had or do you have any of the following?:
Auto accident                                glaucoma
Asthma                            high blood pressure
Arthritis                            hearing loss (which ear?)
Cancer                                low blood pressure
Diabetes                            menstrual pain/discomfort
Fall off horse or other mishap

Please say more about any of these you checked or anything else:


Please answer yes/no or “want to learn more” and add your own comments below:
    I walk/swim/bicycle/run or practice yoga at least 3 times a week.

    I avoid sugar and caffeine (notice I didn’t say “completely”)

    I use journal writing as a stress management tool, or would like to learn more.

Have you taken yoga before? What would you like to get out of this class?

WAIVER: I am aware that yoga, like any physical activity, could result in injury. By my participation in yoga classes taught by Diana Woodall or her designate, I agree to take full responsibility for not exceeding my physical capacity and for any injury that might occur as a result of participation in class.  I have fully informed the instructor of any current or previous medical condition/injury that may affect my participation. I hereby waive any claim I might have at any time against the instructor, Diana woodall, or anyone connected with the premises in any way, for any injury or loss that may occur.

signed________________________________________ date____________

refund policy:  Refunds may be requested before the start of the second class of a session.  After that, there will be no refunds, except in the case of unusual personal circumstance. If there is more than one weather-related cancellation, the instructor may offer a makeup class if she is able to do so.  ​
Copyright © 2021 Diana Woodall
  • Home
  • Yoga
    • Workshops and Sample classes
    • Sign up for session
    • About Shiatsu
  • Schedule
  • Contact
    • contact
    • About Diana
  • GlutenFree
    • Bending toward justice
    • March 23 2020