Prenatal Enrolment Form 

Please note that it is a prerequisite to complete this form before participating in a class with Blueberry Yoga. This information is important and it helps us design the classes in a way that keeps you and your baby safe so please complete it as soon as you can.

It will take about 5 minutes.

 

Please complete the form below

Section A - Personal Information
Name *
Name
Address *
Address
Name of Emergency Contact *
Name of Emergency Contact
Do you consent to us contacting your Obstetrician or Midwife to discuss the details of your pregnancy should it be required? *
Section B - Health Information
High Blood Pressure Low Blood Pressure Recent Surgery Chronic Pain Heart Condition Cancer Stroke Diabetes Ulcer Headaches Hernia Epilepsy Arthritis Anxiety Insomnia Depression Spinal Injury Asthma Joint Replacement Back conditions Pelvic Instability Morning Sickness (Day or Night) Osteoporosis Thyroid Condition Other
Is this your first pregnancy? *
Section C - Current Exercise
Section D - Agreement
It is important to be comfortable and pain-free throughout all activities in class and remain within your personal limitations. If you experience pain or discomfort in any of the practices – STOP – and seek advice *