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YOU & YOUR TEACHING
Forrest Yoga Mentorship Programme (FYMP) — Intake form
Before we work together, I'd like to know more about you!... Your current and past health conditions and/ or injuries and your teaching experience. All of this information is confidential, if you prefer to email me your information,
get in touch
.
1. Your contact information
*
Indicates required field
Email
*
Name
*
First
Last
2. Your emergency contact (friend/family member etc)
Name
*
First
Last
Phone Number
*
Email
*
3. General information about you
Date of Birth (dd/mm/yyyy)
*
Physiological gender: do you have:
*
A vulva
A penis
Both
4. Your general health
Tell me about any past health issues/injuries/conditions/surgeries.
*
What, if any, injuries/conditions/surgeries are you currently working with?
*
If there is anything else you would like to tell me about your health (physical, emotional, Spiritual) feel free to share here.
*
5. If you have a uterus, please answer the following questions. People with a penis, you can go directly to the next section...
Are you currently pregnant?
*
Yes
No
If you ARE pregnant, how many weeks?
*
6. Yoga training
What yoga trainings or relevant complimentary trainings have you completed?
*
If you are currently teaching yoga (in any way) to others, please share details of what you have been doing and how it is going (in your opinion)
*
What would you like to get out of working with me?
*
Is there any reason why you may not be able to work with me? If yes, please specify.
*
7. The legal bit
By submitting this form I acknowledge that I have shared information to the best of my knowledge. I agree to take responsibility for myself during each session with Charlotte Speller. I agree for my details to be used by Charlotte Speller for marketing and communication purposes only. I understand that my personal information is confidential and will never be shared with any third parties without my consent!
IMPORTANT: During
yoga classes
from time to time, I may record or take photos for education or marketing purposes. If for any reason you do not consent to this, please
get in touch
. When participating in
trainings online
, the content is recorded for participants to access for a limited time after the training. The training may also be sold separately, in such cases, content will be reviewed and any content deemed personal shall be removed from the recording.
I am really looking forward to us working together soon!
LOVE Charlie
Submit