Name *

First Name

Last Name

Are you experiencing any of the following?

aching hips

back pain

fluid retention

leg cramps

heartburn

nausea

insomnia

high blood pressure

low blood pressure

other

What would you like to gain from these classes?

relaxation

stress management

physical strength

stretching + flexibility

relief from back or neck pain

improved sleep

confidence + connection with my inner wisdom

birth preparation

connection with my baby

other

Agreement *

I understand that the instructions given throughout the classes are intended only as a guide, and It is my responsibility to: 1. Adjust my practice according to my limitation to ensure no personal injury occurs. 2. Inform the teacher before class of any recent change to my physical condition. I hereby declare that I release Laura Gilbert of any responsibility for any injury sustained and that I will take full responsibility for myself and my baby during the yoga classes.

I agree