Full name

Email address

Contact Phone

Birthday

Day

Month

Year

Address

Emergency Contact name

Emergency Contact Number

Have you practised yoga/Pilates before?

Are you currently under the care of a healthcare professional? If yes tell us a little below.

Do you have any injuries, medical conditions, or ongoing concerns we should know about?

Do you suffer from back or neck pain?

Yes

Have you ever been told you have arthritic joints, osteoporosis, osteopenia or any bone or joint problem that may be made worse by exercising?

Arthritis

Osteoporosis/osteopenia

Any other bone or joint issue

None

Do you have pain or restricted movement in any other joints (e.g. Hip, Knee, Ankle, Shoulder)?

Are there any movements that cause you pain? If so please describe

Have you ever been diagnosed as Hypermobile (excessive joint mobility)?

Yes

Are you or have you been pregnant in the last 6 months?

Yes

Is your blood pressure

Normal

Low

High

Has your doctor ever said that you have any sort of heart trouble or defect?

Yes

Do you ever lose your balance because of dizziness or do you ever feel faint or dizzy?

Yes

Do you suffer from Asthma, Diabetes, or Epilepsy?

Asthma

Diabetes

Epilepsy

N/A

Are you taking any drugs or medication which may affect your ability to exercise?

Are there any health problems, not already mentioned, that may affect your ability to exercise?

Do you have medical permission to exercise?

Yes

Not required

What are your reasons for joining Kasara? What health or physical goals would you like to achieve over the next 6 months?

Health & Participant declaration

I confirm that I am fit to take part in Pilates, Yoga & movement sessions with Kat & Sarah (Kasara). I will inform my teacher of any injuries, medical conditions, pregnancy, or changes to my health that may affect my ability to exercise safely.

I understand that I participate at my own risk and will work within my own limits, following all guidance given. I acknowledge that movement sessions may include hands-on guidance unless I request otherwise.

Kasara sessions are not a substitute for medical advice or treatment. If I have any concerns about my suitability to exercise, I will consult an appropriate healthcare professional.

I consent to the information provided being held securely, and used solely for teaching, safety, and communication purposes. My details will remain confidential and will not be shared with third parties without my permission.

By clicking submit, I confirm I have read, understood, and agree to the above terms.

We look forward to welcoming you!

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Event you are booking

Enrolment Form

This enrolment form applies to all Kasara events and workshops. Please complete this form to secure your place.