Health Declaration

Please fill out the following health declaration form in order to participate in our 30 day challenge. 

Pre-Activity Readiness Questionnaire

This questionnaire is to ensure that you are healthy and able to take part in physical exercise, if there are any potential issues, you will be required to seek your doctor’s consent before continuing:

Checkbox here: 

Please read all questions carefully and answer as appropriate:

If you checked any of the boxes above, please give further information in the box below: 

INJURIES

Please list any past and current injuries below: 

PAST INJURIES - PLEASE LIST HERE

CURRENT INJURIES - PLEASE LIST HERE

FINAL POINTS: 

Please tick the box below to confirm that the information you have given in this form is accurate, and that you understand it is your responsibility to check with your doctor if you have any difficulties or concerns about your ability to participate in a yoga class, and that you are responsible for notifying me if any of this information changes.

By submitting this form you confirm you have read and accepted our terms and conditions, including the cancellation policy, and that you accept that Lana King and Move with Lana is not liable for any injury, or damages, to person or property, resulting from the taking part in these yoga class.

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