Health & Dietary Questionnaire

This questionnaire has been designed to help you to enjoy your yoga retreat safely. All information given will remain private and confidential.

Yoga experience

Medical Status


(It is advisable not to resume any form of exercise for 12 weeks following the birth.)
NB: If you are pregnant or become pregnant please inform your instructor.

Past History

Dietary Requirements

Other Information

I, being aware of my own health and physical condition and having knowledge that my participation in any yoga retreat may be injurious to my health, am voluntarily participating in the yoga retreat with Yoga with Zoe. Having such knowledge, I hereby release Yoga with Zoe from liability for accidental injury or illness, which I may incur as a result of participating in the said yoga retreat. I hereby assume all risks connected therewith and consent to participate in the said yoga retreat. I agree to disclose any physical limitations, disabilities, ailments or impairments, which may affect my ability to participate in the said yoga retreat.
With regards to all forms of exercise if you have any doubt about your level of health and fitness it is advisable to consult your GP prior to the commencement of any new fitness plan. The instructor must be informed of any injuries, handicaps or medical problems prior to joining the Yoga Retreat. Yoga with Zoe cannot accept responsibility for personal injury whilst participating in the Yoga Retreat if:
a) You have been advised against exercise on the basis of a pre-existing health condition by your GP. b) You fail to observe the techniques & instructions given regarding safety.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.