Student Registration Form

This form must be filled out and signed by every new student/client prior to joining a class, workshop or course for the first time. (The terms "Student" and "Client" are interchangeable). 

Please read the CAUTION notice given with the Registration Form. 

The Yoga teacher will interview a prospective new student prior to beginning a class. In the interview the teacher assesses the suitability of the new student for the practice, considering their age, experience/no experience in Yoga, their health and fitness level, illness, injuries, etc.

After discussing these issues with the new student, and after the student has read, understood and signed the "CAUTION Notice" and the "Student Registration Form" (both are shown below), and read "What Shanthi Teaches""Yoga Etiquette" and "FAQ's... and things you probably need to know" pages on this web site, Shanthi Bhavana will decide whether to admit the person as a new student.

Please review the "Student Registration Form" (here) and the "CAUTION Notice"(below). A similar form and Caution Notice will be given to a prospective new student prior to starting a class. The form helps the teacher to understand about the student's health, fitness and injuries, so that they can assist the person and work with them to achieve the person's health goals.  All information and contact details given remain confidential.

 

Shanthi Bhavana Meditation & Yoga

 

STUDENT REGISTRATION FORM

 

Welcome to Shanthi Bhavana Meditation & Yoga.

This class is based in Yoga Therapy. This is a confidential form with your personal information that will help enhance your class experience.

The information will help your teacher assess your needs and provide you with what is appropriate to you, individually, according to your health and fitness.

All the information on this form will be kept confidential between the participant,

(your NAME here)______________________________________ and Shanthi Bhavana Meditation & Yoga.

Our aim at Shanthi Bhavana Meditation & Yoga is to enhance your yoga experience and create optimum health and wellbeing, in a safe practice. Therefore this document is a legal requirement and a prerequisite to being accepted as a student.

Thank you for taking the time to fill out details correctly. Please sign where indicated at the end.

Name:______________________________________________

Date of Birth:_______________________________________________

Address:_____________________________________________

Email:  (Please PRINT clearly in CAPITALS)____________________

Phone:________________________________ Emergency Contact: (Name & Phone)__________________________

Occupation___________________________________________

Class attended today (DAY & TYPE of YOGA class)_________________________________________________

Please check appropriate boxes x

Have you done yoga before?   YES   NO

If so, when was the last time you went to yoga?___________________________________________________

 What style or tradition of yoga have you practiced?___________________________________________________ 

Do you have any previous injuries or pain in the following?

Back       Neck   Legs   Arms      Shoulders       Hips

Are you under the care of a health professional?

Doctor

Physio

Chiropractor

Occupational Therapist

Massage Therapy

Naturopath

Other_______________________________________________

Do you have any current medical conditions?

Diabetes      Anaphylaxis      Stroke      High/Low Blood Pressure      

Vertigo      Allergies      Asthma      Respiratory (other)      

Seizures / Epilepsy    Sleep problems     

Heart Condition  Emotional/Mental state (Depression, Anxiety)  

Digestive System     

Other

Briefly describe:

___________________________________________________

Are you on any medication?  YES   NO

If so, what medication? (please include Herbal Medicines)____________________________________________

Have you been in surgery in the last 12 months?  YES   NO

Are you pregnant?   YES   NO

Please Note: Shanthi Bhavana does not provide a Pre-Natal Yoga service and therefore does not accept students/clients who are pregnant. If you are pregnant, or become pregnant at any time, you must inform Shanthi Bhavana immediately. In the event that you become pregnant we can assist by referring you to a Yoga teacher who offers Pre-Natal Yoga.

Please explain what outcome you would like to achieve from YOGA:

___________________________________________________

About your email address, confidentiality and ongoing information:

Please check that you have given the correct email address and that it is printed clearly and legibly. The email address that you have given will not be given or sold to any third party.

As your Yoga health and wellness practitioner, Shanthi Bhavana Meditation & Yoga offers FREE continued support external to the classroom environment, by giving educational information exclusively to its client/student members, assisting them with knowledge about Yoga Therapy, health and wellness. Is it okay with you for us to send you newsletters and information about Yoga health and wellness, classes, timetable changes and future workshops and retreats?   YES   NO

Photography / Video Release:  From time to time we may wish to take still photographs and/or video during our class, for promotional or educational use on our web site or on special training media (e.g., DVD, flyers, booklets) for ongoing Yoga education. Do you give us permission to use images/video of you for these professional purposes?    YES   NO

SHOULD YOU HAVE ANY CONCERNS WHETHER YOU ARE ABLE TO PARTICIPATE PLEASE CONSULT YOUR HEALTH PROFESSIONAL PRIOR TO COMMENCEMENT

I am aware of the risks, dangers and obligations set out below in this acknowledgement and release.

My teacher has brought to my attention the CAUTION notice, which I have read, understood and acknowledge.

By signing this form I acknowledge the risks, dangers and obligations and I participate in the activity at my sole risk and responsibility.

 

RELEASE AND INDEMNITY

·       I release, indemnify and hold harmless the teacher, Shanthi Bhavana, and Shanthi Bhavana Meditation & Yoga, its servants or agents, from and against all and any actions or claims which may be made by me or on behalf of me, by other parties.

·       I also agree that if I am injured or my property is damaged, I will bring no claim, legal or otherwise, against Shanthi Bhavana, or Shanthi Bhavana Meditation & Yoga in respect of that injury or damage. 

Thank you for taking time to fill out this form today. Please check to make sure this information is correct.

 

Signature: __________________________________________________

Date:______________________________­­________________

 

Welcome to Shanthi Bhavana Meditation & Yoga!

Sri Shanthi Bhavana

Director – Yogacharya – Teacher, Educator, Yoga Media Producer

Shanthi Bhavana Meditation & Yoga

Certified Yoga Trainer - IICT (International Institute for Complementary Therapists)

(0466) 480-369

info@shanthibhavana.com

www.shanthibhavana.com


Here are some Cautions to be aware of before starting:


Caution Notice

Please take a moment to read these cautions prior to YOGA 

·     Caution should be taken for people at risk or people presenting with conditions that, by participating in yoga exercise, might result in pain, trauma or discomfort.

·     In you have any concerns about your health - in particular, Heart or Blood Pressure (Hight ot Low) - Please consult with your doctor before starting this, or any other, exercise program.

·      Please consult with your doctor before starting this, or any other, exercise program. Please consult with your doctor before starting this, or any other, exercise program. 

·      It is in your interest to inform your Yoga teacher of any illness, injury, medical condition or anything else that may adversely affect your ability to practice Yoga.

·      Not all exercises are suitable for everyone, and participation in this Yoga program may result in injury, if not performed correctly. If you experience pain during exercise, stop immediately, inform your teacher, and consult with your doctor.

·      Women who are menstruating should not practice inverted poses, back bends, or vigorous standing poses. There are poses more suited for women experiencing menstrual discomfort and pain - your teacher can advise you.

·      Women who are pregnant should inform their teacher before practicing Yoga.

·      This class does not accept students who are pregnant – we do NOT offer Pre or Post-Natal Yoga, however we are happy to refer a pregnant student to a Pre-Natal and Post-Natal Yoga teacher.

·      It is not necessary to execute every Yoga Asana (posture) or breathing exercise. Not every part of the practice will suit every person. Yoga should be tailored to suit every individual. If there is anything that does not feel right, leave it out, do not attempt it – rest, and then try something else. Your teacher will assist you to find a practice that is suitable specific to you, to your individual needs.

·     Always work within your range of limits and abilities.

·     Do not push through pain.

·     Do not push yourself to try more advanced postures if you are a beginner. Work with simpler versions and only move to more advanced postures and sequences when you have mastered these, and can practice them easily and without discomfort, pain, excess exertion or stress to the body.

·     If a posture, movement, or sequence does not feel right, for any reason, or if you experience pain, dizziness or any feelings of unease - stop immediatley and rest.

·      The teacher cannot guarantee that this Yoga practice is safe for every individual. Any liability, injury, loss, or damage in connection with this program is expressly disclaimed.

·      Please practice Yoga with Mindfulness, for You, and others.

Thanks for taking the time to read this and for caring for your body.

Namaste!


Here are some Tips to consider before starting Yoga: 

·      To reduce risk of injury, never force or strain during excerse. If you experience pain or discomfort during exercise, stop immediatley and consult your doctor or health care professional.

·      Make sure you warm up and limber the body before attempting bigger stretches.

·      Shortness of breath or sweating is the first sign that you may be over doing it. Reduce the effort, slow down, take smaller movements, breathe deeper, or just pause and rest for a while.

·      Other special cautions may apply to individuals with special health issues. For that reason, you should consult your doctor or health care professional to find out if special restrictions apply to you. If so, please advise your teacher immediately so they can respect these restrictions and work with you to achieve greater health benefits, safely.

·      Make sure you always have plenty of water available to drink before, during and after your pratcice. A small rest and a few sips of water between postures is good.

·      Not every posture is right for every person - Yoga is an individual practice: find what works for you; allow your instructor to help advise what is right for your body and level of fitness; do not push past pain, or your level of fitness; there are hundreds of postures - the rule in Yoga is: if one posture does not suit you, leave it out as there are many other alternatives that you can use.

·      Relax into the postures - always use the breath in synchronisation with movement.

·      Always listen carefully to your instructor and ask questions at any time, especially if you are not sure about anything.

·      Constantly self-assess what is happening in your body and how you feel - then adjust your practice accordingly. Never push past your comfort zone. (Yoga is not a "no pain, no gain" practice). There must never be pain. Yoga is practiced by gentle movement, always linked with the breath and mindful attention to the practice.

·      Yoga is a practice that requires mindful attention, and HathaVinyasa and Restorative Yoga, and Chair-adapted Yoga are practices that are based around mindful awareness - Yoga IS meditation, so please be aware; be cautious and mindful about your practice.

·      Practice YOGA with Mindful Awareness - for You and others.

Thanks for taking the time to read this, and for caring for your body.

Namaste!


 

© Shanthi Bhavana 2016