Registration Form

Postnatal & Baby Yoga

The following information is required in order to best prepare your class, taking into consideration your individual needs. All this information is kept confidential and secure, and will not be shared with third parties. I ❤ privacy and care about yours.

Name

First Name

Last Name

Date of birth

(DD/MM/YYYY)

Phone

(please include country code)

Do you wish to receive a text reminder 30 minutes before the class?

Address

(for State/Province, type N/A if not needed)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Baby's name

First Name

Last Name

Baby's date of birth

(DD/MM/YYYY)

Is it your 1st/2nd/3rd/4th/more child?

Delivery mode

(Please indicate if you've had an intervention or assisted delivery)

Do you or your baby have a medical condition (predating or resulting from the pregnancy or delivery)?

Anything else I should know about you and your baby?

Emergency contact

First Name

Last Name

Emergency contact phone number

(please include country code)

Signature

Date

(DD/MM/YYYY

Registration Form

Postnatal & Baby Yoga

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