Enrolment form

Full name

Email address

Contact Phone

Birthday

Day

Month

Year

Address

Emergency Contact name

Emergency Contact Number

Have you practised yoga/Pilates before?

Are you currently under the care of a healthcare professional? If yes tell us a little below.

Do you have any injuries, medical conditions, or ongoing concerns we should know about?

Do you suffer from back or neck pain?

Yes

No

Have you ever been told you have arthritic joints, osteoporosis, osteopenia or any bone or joint problem that may be made worse by exercising?

Arthritis

Osteoporosis/osteopenia

Any other bone or joint issue

None

Do you have pain or restricted movement in any other joints (e.g. Hip, Knee, Ankle, Shoulder)?

Are there any movements that cause you pain? If so please describe

Have you ever been diagnosed as Hypermobile (excessive joint mobility)?

Yes

No

Are you or have you been pregnant in the last 6 months?

Yes

No

Is your blood pressure

Normal

Low

High

Has your doctor ever said that you have any sort of heart trouble or defect?

Yes

No

Do you ever lose your balance because of dizziness or do you ever feel faint or dizzy?

Yes

No

Do you suffer from Asthma, Diabetes, or Epilepsy?

Asthma

Diabetes

Epilepsy

N/A

Are you taking any drugs or medication which may affect your ability to exercise?

Are there any health problems, not already mentioned, that may affect your ability to exercise?

Do you have medical permission to exercise?

Yes

No

Not required

What are your reasons for joining Kasara? What health or physical goals would you like to achieve over the next 6 months?

Health & Participant Declaration

I confirm that, to the best of my knowledge, the information I have provided is accurate and that I am able to participate safely in Kasara sessions. I will tell Sarah or Kat about any injury, medical condition, pregnancy or change to my health that may affect my participation.

I understand that movement involves some risk of injury. I will follow the guidance given, work within my own limits and stop if I experience pain, dizziness or feel unwell.

Hands-on guidance may be offered and will only be used with my consent.

Kasara sessions are not a substitute for medical advice or treatment. If I have concerns about my suitability to exercise, I will consult an appropriate healthcare professional.

I have read Kasara’s Privacy Policy and understand how my information will be used.

By submitting this form, I confirm that I have read and agree to this declaration.

Yes, subscribe me to your newsletter.

Event you are booking

I explicitly consent to Kasara processing my health information to assess my suitability and support my safe participation. I may withdraw consent at any time, but Kasara may then be unable to offer me a place.

Enrolment Form