Client Registration Form

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karen@thecalmspace.co.uk | 07981286767

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Gentle Yoga, Pregnancy Yoga, Baby Massage and More

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HOME
- FINDING YOUR CALM SPACE BOOK
CLASSES AND THERAPIES
GIFT VOUCHERS
LOCATION
ABOUT ME
BLOG
- Blog Submission Guidelines

HOME
- FINDING YOUR CALM SPACE BOOK
CLASSES AND THERAPIES
GIFT VOUCHERS
LOCATION
ABOUT ME
BLOG
- Blog Submission Guidelines

Thank you for completing this form. Please be assured that all information will be kept securely and in strict confidence, and will be used only for the purposes of ensuring your safe and positive experience at our classes and events.

Name *

First

Last

Email *

Phone

How did you hear about The Calm Space?

Google search
Facebook
Instagram
Friend or family member
Other

Do any of these health conditions apply to you? *

High or low blood pressure
Asthma
Diabetes
Epilepsy
Heart problems
Recent fractures or sprains
Back, hip, or neck problems
Other joint problems or injuries
Recent surgery
Cancer
Depression or anxiety
Other
No significant health issues

Please give details of any health conditions you have indicated above

Are you pregnant? *

If you are pregnant, what is your estimated due date?

Is this your first baby?

In this pregnancy, have you experienced any of these issues? *

High or low blood pressure
Severe sickness
Pelvic pain or mobility problems
Depression or anxiety
Sciatica or lower back pain
Fainting or dizziness
Wrist pain/carpal tunnel syndrome
Multiple pregnancy
Threatened miscarriage*
Pre-eclampsia*
Placenta Praevia*
Any other health issues
No significant health issues

*Please note that Pregnancy Yoga may not be suitable if these conditions apply

Have you had a baby within the last twelve months? *

Type of birth *

Uncomplicated vaginal birth
Forceps or ventouse
Caesarean section

Date of your baby's birth *

If you are bringing your baby to classes, what is your baby's name?

Does your baby have any ongoing health issues?

If your baby has any ongoing health issues, please obtain advice from a health professional (GP, Practice Nurse, Health Visitor or other suitable professional) before attending Baby Massage or Mother and Baby Yoga classes.

I am satisfied that it is safe for my baby to undertake the intended classes *

I understand that my personal health information will be collected. The Calm Space collects your data so that we can manage your account and bookings, email you on products and services which may be of interest to you, and ensure that our services are suitable for you. Your data will not be shared with anyone else unless you give specific consent. Your data is stored securely on the secure servers of WordPress. A printed copy of your data may also be stored securely in a locked filing cabinet in the locked house at 231 Stock Road, Billericay, CM12 0SG, United Kingdom. Your data will be kept for five years. You have the right to request to see copies of your personal data. We may charge a small fee for this service. *

Yes I agree that my data may be collected and stored as described above

I take full responsibility for my health and wellbeing during the classes and outside the classes, including any injuries. I fully understand and acknowledge that the recommendations, ideas and techniques expressed in these classes cannot be regarded as substitute for the advice of a qualified medical practitioner. I understand that I should seek the advice and care of my own doctor, midwife or other medical professional for all health or pregnancy related matters. If I bring a child with me to any class, I acknowledge that I am fully responsible for the health and wellbeing of the child in my care at all times during the class. I understand and acknowledge that this is not a childcare session. *

Yes I agree to the above statement

I am happy for The Calm Space to contact me by email for the purpose of providing news and information about offers, classes and events *

I give permission for any photographs of myself or my child taken at Yoga classes or events to be used for promotion of future classes or events by The Calm Space. Only appropriate photos will be used for promotional purposes and never sold or transferred to third parties. The images may be used across a range of online and offline channels (including, but not limited to, web/social media and email). Class participants will not be identified by their name when using the images. The images may be used and stored for a period of up to 5 years. Please note that we cannot take responsibility for photographs / video clips that are taken by others in public spaces. *

Phone

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Email Address *

First Name

Last Name

Interests

Yin and Restorative Yoga
Pregnancy Yoga
Baby Massage
Mother and Baby Yoga
Reflexology

Marketing Permissions

The Calm Space will use the information you provide on this form to be in touch with you and to provide updates and marketing. Please let us know all the ways you would like to hear from us:

You can change your mind at any time by clicking the unsubscribe link in the footer of any email you receive from us, or by contacting us at karen@thecalmspace.co.uk. We will treat your information with respect. For more information about our privacy practices please visit our website. By clicking below, you agree that we may process your information in accordance with these terms.

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