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British Wheel of Yoga

British Wheel of Yoga STUDENT HEALTH QUESTIONNAIRE Revised 23rd December 2020

To be completed by yoga class participants for face to face and remote teaching. All information given will be treated in the strictest confidence and stored in accordance with General Data Protection legislation.

Date of Birth
Day
Month
Year
Gender
Male
Female
Other
Have you attended a yoga class before?
Yes
No
The following information is required to ensure your health. Whilst yoga may be practised safely by most people, there are certain conditions that require special attention. If you are unsure please consult your GP before commencing class. Please indicate
These conditions may affect your practice and so it will be useful for your tutor to be aware of them:
Please tick (or otherwise indicate) in this box if you do not wish to declare medical information.

I do not wish to declare medical information
Have you had any recent operations (in the last two years)?
Yes
No
Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by yoga practice?
Yes
No

Disclaimer:

Please take care when filling in this questionnaire and check the contents are accurate before you submit it. By submitting the questionnaire, you are confirming that the contents are true and accurate to the best of your knowledge. Please notify your teacher of any changes to your responses in this healthcare questionnaire before participating in classes subsequent to those changes.


Neither your teacher nor the British Wheel of Yoga are qualified to express an opinion that you are fit to safely participate in any British Wheel of Yoga organised sessions or any British Wheel of Yoga trained teacher’s yoga classes. You must obtain professional or specialist advice from your doctor before participating if you are in any doubt.


All of our yoga instructors are appropriately qualified or British Wheel of Yoga Accredited teachers, with high standards of teaching and best practice. Where possible, your teacher may offer suitable modifications or adjustments and practices to suit different levels of experience and ability.


Please always let the teacher know before the class if this is your first time practicing yoga or if you are not confident about your experience and/or ability. Where you are taking part in live-streamed classes, please note that the instructor may not be able to see you at all times. Where you have declared a health condition, please contact the teacher before the class if you would like to request that you are provided with suitable modifications or adjustments wherever possible. Please note, where you are taking part in a pre-recorded class, you will not be able to request specific adjustments or modifications.


In all classes whether face to face, live streamed remote or pre-recorded remote, always follow your teacher’s safety instructions and listen to your body. Where a movement or class is beyond your experience or ability, feels too difficult for you, or you experience any discomfort, please do not continue the movement or class.


By signing this disclaimer you acknowledge that when participating in yoga workshops offered by Yoga with Charlotte Swann, you will receive information and instruction about yoga, meditation, mindfulness, physical exercise or health. You recognise that exercise requires physical exertion, which may be strenuous and may cause physical injury, and you are fully aware of the risks and hazards involved.

You understand that it is your responsibility to consult a physician prior to and regarding your participation in the yoga workshops offered by Yoga with Charlotte Swann. 

You represent and warrant that you are physically fit and  have no medical condition which would prevent your full participation in these workshops.

You understand that these workshops, by default, are not suitable for pregnant students. 

If you are pregnant you understand that you participate fully at your own risk and that of your unborn child/children.

In further consideration of being permitted to participate in these yoga workshops, you knowingly, voluntarily and expressly waive any claim you may have against Yoga with Charlotte Swann for injury or damages that you may sustain as a result of participating in these programmes.

You understand that from time to time during yoga workshops, the instructor may physically adjust students’ form and posture. If you do not want such physical adjustments, you will so inform the instructor at each workshop you attend. You also acknowledge that if you do wish to receive such adjustments, it is your responsibility to inform the instructor when an adjustment has gone as far as you desire at that time.

If you do not return this questionnaire to your teacher prior to taking part in a class or workshop, your teacher will assume that you do not have any existing health conditions or concerns to declare. Please contact your teacher immediately if your circumstance change or speak with your yoga teacher prior to taking part in a class if you have any concerns. Your teacher will be unable to make modifiactions or adjustments to the exercises for health conditions that are not declared. Your teacher will not be responsible where you fail to return the health questionnaire, or where you do not declare a health condition to your teacher or to BWY (whether by returning the questionnaire or in some other communication), and an issue arises as a result.

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Date
Day
Month
Year

GDPR Statement:

In order to comply with the General Data Protection Regulations, it is necessary for me to check whether or not you are happy for me to retain your contact details, and to send you information that I think may be useful to you, including training and events, and relevant updates. I only hold information when it is necessary to do so in order for me to carry out my work, and when you have given me permission to do so. To ensure that I only communicate with you in the manner of your preferred choice, please will you indicate below, your agreement, or otherwise, to the following means of communication:

Contact via email;
Yes
No
Contact via Messenger:
Yes
No
Contact via Whatsapp:
Yes
No

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