Name *

First Name

Last Name

Phone

(###)

###

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Emergency contact

(###)

###

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Please select any of the below that are relevant

Labour was self-starting

Labour was induced

Labour was accelerated

I had a c-section

I had a 2nd degree vaginal tear

I had a 3 or 4 degree vaginal tear

I had an assisted birth

Postnatally, have you experienced any of the below?

Sciatica

Prolonged bleeding

Back pain

Depression

Anxiety

Anaemia

Exhaustion

None of the above

Please confirm you have been signed off by your GP to exercise since giving birth * *

I agree

I consent to my data being held for 5 years, for insurance purposes. *

Yes

Please confirm you are either minimum 6 weeks postpartum if you had a vaginal birth with no assistance or third or fourth degree tearing; or a minimum 10 weeks postpartum if you had a c-section, third or fourth degree tear or assisted birth (forceps or vontuse) * *

Yes

As far as I am aware, I have disclosed to my teacher all information regarding my birth relevant to the practice of postnatal yoga. I take full responsibility for all applications of yoga I practice in class and outside the class. I fully understand that these recommendations, ideas or techniques expressed and described in these classes cannot be regarded as a substitute for the advice of a qualified medical practitioner. Any uses to which the recommendations , ideas and techniques are put are at my sole discretion and risk. * *

Yes

I have read and agreed to the Terms and Conditions

Refunds will not be given for cancellations with less than one weeks notice before the block starts. You may roll one session per block over to the next session if you are unable to attend. Mother Your Way cannot be held responsible for any decisions that you make regarding your pregnancy and birth. Any questions or doubts you have about you the use of Hypnobirthing or yoga should be taken up with your health care professionals.

Yes