Forms | The Blissful Canary

Please fill out the following form to help us understand your physical condition to ensure we provide you with a safe and personalised practice.

First Name

Email Address

Last Name

Date of Birth

Have you been hospitalised in the last 12 months or are you currently suffering from a medical condition, illness, or injury?

Yes

Have you read and do you agree to The Blissful Canary waiver form, terms and conditions and code of conduct (located below)?

Yes

If you answered yes to being hospitalised, currently suffering a medical condition, illness or injury, please elaborate below....

Initials - by initialling this form you agree that you have read and agree to all terms and conditions.

Today's Date

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

Thanks for submitting!

The Blissful Canary
Private Yoga Studio