yoga & meditation enrolment
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  *Name:
  *Age:
  *Address:
  *Date of Birth:
  *Telephone home:
  *mobile:
  *email:
  *occupation:
  *sports/activities?:
  *serious illness/injury?:
  *when was this?:
  *spinal disorders?:
  *recent surgery?:
  *heart or circulation problems?:
  *medications?:
  *asthma/sinus?:
  *Are you pregnant?:  Yes
 No
  *why have you chosen to come to yoga?:
  *How did you hear of my classes?:
 
 
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