Your Name (required)

Your Email (required)

Address

Date of Birth YYYY-MM-DD (required)

Telephone no. (required)

Emergency contact

Occupation

Baby's name

Baby's Date of Birth YYYY-MM-DD (required)

How did you hear about the class?

Have you studied yoga before?

What do you hope to gain from the baby yoga class?

If applicable, did you have a vaginal or cesarean delivery?

Do you have any medical conditions or injuries, or have you undergone surgery which could affect your yoga practice? Please give details.

Are you taking any medication?

Does your baby have any medical conditions or injuries?

Is your baby taking any medication?

Ages of other children

If applicable, are you currently breastfeeding?