Register ( New Students Only ) New Student Registration FormEmail address*Phone*GoPlease enable JavaScript to submit this form.NameFirstLastStreet Address*ZIP / Postal Code*State / Province / Region*City*Country*BackGoEmergency Contact Name*Emergency Contact Phone Number*BackGoHow did you find out about HOUSE OF HARMONY ?Family/FriendsLocal Business FlyerSearch EngineSocial MediaOtherBackGoPlease tick all relevant health historyAsthmaArthritisNeck/Back problemsShortness of breathStrokeDiabetesHigh blood pressureDizzinessEpilepsyLow blood pressureOverweightChest painSedentary lifestyleJoint problemsSmokerEye problemsHeart conditionBone/Joint damagePlease provide further detailsWe need a note from your health practitioner allowing you to participate in any yoga or fitness related activity is mandatory. You are not permitted to attend a HOUSE OF HARMONY class until clearance is obtained.Does your family have a history of any of the conditions above?YesNoPlease provide detailsAre you pregnant, or have you given birth in the last six months?YesNoPlease provide detailsAre you taking any medication that will affect your physical performance?YesNoPlease provide detailsDo have any injuries or recent surgeries that may restrict your yoga practice?YesNoPlease provide detailsAre there any other medical conditions, physical restrictions or special considerations Viktoriya should know of?YesNoPlease provide detailsBackGoHave you practiced Yoga before?YesNoWhat type and for how long?Are you currently involved in a regular fitness program?YesNoPlease provide detailsWhat do you wish to learn or achieve from your HOUSE OF HARMONY practice?BackGoInformed Consent*HOUSE OF HARMONY recommends that health approval be obtained before beginning an exercise program. • I understand that HOUSE OF HARMONY will not be held responsible for any neglect on my behalf to seek medical approval prior to commencing a Yoga practice. I also understand that classes taught at HOUSE OF HARMONY are not meant to replace any form of medication or medical treatment that I am currently seeking now or in the future. • I have been informed and understand that strength, flexibility and cardio vascular exercise, including Yoga, are potentially hazardous activities. I also have been informed and understand that these activities involve a risk of injury and that I am voluntarily participating in these activities with full knowledge and appreciation of the dangers involved. • I have read, understand and agree to follow the HOUSE OF HARMONY studio etiquette, policies and procedures as well as the conditions of classes. • I understand that it is essential to book into any given class to secure a place. If I then cancel with less than 36 hours notice prior to the scheduled class or fail to show I will be given grace on the first occasion, but repeated late cancellations or no-shows will result in my paying the cost of the class. • I declare all of the information provided by me to be correct to my knowledge and have not withheld any information that may result in any consequences. • I agree to advise Viktoriya Mateva of HOUSE OF HARMONY in writing if any of the information provided by me changes. • Agree to the informed consent and booking terms and conditionsYes, I agreeDate*Sign below* Clear Signature*BackRegisterThis field should be left blank
