Yoga Profile

First name
Surname
Date of Birth
Email address
Repeat email address
Mobile telephone number
Occupation
Height
Weight
Sex:		Male Female
Date of Travel

Person to contact in case of emergency:
Name:
Telephone
Mobile

Travel Details
Are you travelling on recommended flights?

Please specify your outgoing flight details including flight number, departure and arrival times.

Please specify your return flight details including flight number and departure time.

Travel Insurance Details
Insurance company name
Insurance policy number:
Insurance company emergency telephone number:

Medical details and physical activity readiness
This section of the form has been designed to identify anyone for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. It also gives our personal trainers the opportunity to review everyone’s fitness levels in advance and prepare the schedules accordingly.

Has your doctor ever said you have heart trouble? yes No
If so, please specify:

Do you ever have pains in your heart and chest? yes No
If so, please specify

Do you ever feel faint or have spells of dizziness? yes No
If so please specify

Has your doctor ever told you that you have a bone or joint problem, such as arthritis that has been aggravated by exercise, or might be made worse with exercise? yes No
If so please specify

Do you suffer from any problems of the lower back yes No
If so please specify

Are you currently taking any medications? yes No
If so please specify

Do you currently have a disability of a communicable disease? yes No
If so please specify

Do you have any other medical issues or injuries that you should inform us about yes No
If so please specify

Is there a good physical reason, not mentioned here, why you should not practice yoga even if you wanted to? yes No
If so please specify

Diet
Do you have any special dietary requirements? Yes No
If yes, please describe them here.
Your Current Yoga Practice
Have you practiced yoga before? Yes No
Are you currently practicing yoga? Yes No
How many years have you been practicing yoga?
Please describe your current yoga practice.
Which style(s) have you been practicing, including the names of any teachers you have been working with.
What level would you consider yourself to be? Beginner Intermediate Advanced
Aims and Expectations
What are your goals for your time with destination yoga?
* Please tick here to confirm that you have read, understood and answered all questions to the best of your knowledge
Many thanks for your time.

Yoga Profile

Travel Insurance Details

Medical details and physical activity readiness

Diet

Your Current Yoga Practice

Aims and Expectations