Umbrella Yoga

Kirklees Wellbeing Yoga Health Questionnaire

Umbrella Yoga

Kirklees Wellbeing Yoga Health Questionnaire

​We are collecting this information so that we can prepare for your yoga session as best we can. This information will be stored securely, never be shared with a third party, and will be deleted upon your request.

Yoga includes physical movement as well as an opportunity to relax. As with any physical activity, there is the possibility of injury, and certain movements may not be appropriate for some people. Please let us know of any pre-existing health conditions so that your teacher can guide you safely in your practice.

Listen to your own body - if you experience any pain or discomfort, please stop!​​

Contact Information

Please provide your contact information so we can share updates on these sessions.

Which area do you want to attend?

(You can put more than one)

Have you already been in touch with anyone at Umbrella?

Are you joining a session with another organisation?

What is your gender?
What is your ethnicity?
Are you pregnant, or have you been pregnant in the last 3 months?

Do you have any of the following medical conditions:


By agreeing to this statement you confirm that you have read and understood this health questionnaire, that you take responsibility for your own health and wellbeing, and that you are happy to participate in the yoga session. *
Can Umbrella Yoga use photos of you on their website and social media? (names will not be used)
Can Umbrella Yoga use your comments and feedback on their website and social media? (names are not needed)
We would like to contact you occasionally with details of other sessions you might be interested in and news about our service. We will NEVER share your contact details with anyone else. Please tick the boxes below to indicate if we may contact you: