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Hannah Smalley, Yoga Teacher, Wiltshire

Blossom Yoga

Emergency Contact Form

YOUR OWN DETAILS:

First Name

Last Name

Email

Phone

Address

YOUR EMERGENCY CONTACT DETAILS:

Contact First Name

Contact Last Name

This contact is my

Contact Phone Number

Contact Email

Thanks for submitting!
We’ll contact this person only in case of emergency.

Health Declaration Form

First Name

Last Name

Email

Date of Birth

Have you had a major injury in the last 5 years? *

No

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Address

Thanks for submitting!

Blossom Yoga

blossomyogastudio@outlook.com

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