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Please answer all the questions below. The following information is required to ensure your safety. There are some medical conditions which require special attention when practicing Qigong. If you are unsure please consult your GP before attending class.

These conditions may affect your practice, so provide information for yoga tutor:

Other (Discuss with Tutor):

Do you have any old injuries that still trouble you and are not on this list? Please provide details:

If YES please seek advice from your doctor or other health professional before starting to practice.

Other Reason (Please specify):

Declaration: I confirm the above information is correct. I understand it is my responsibility to:

• Check with my doctor if I have difficulties about my ability to participate in yoga class

• Advise tutor of any change in medical information

• Follow advice given by my yoga tutor

All personal information will not be shared or sold and will be for the sole use of Craigsfarm Community Hub. I give permission to Craigsfarm Community Hub to use photographs obtained during classes, workshops and events to use as part of a public display which may include Craigsfarm Community Hub website and other print publications.

Data Protection: Craigsfarm Community Hub complies with data protection law in the UK and laws in other countries that meet internationally accepted standards. You have the right to ask for a copy of the information we hold on you, and the right to ask us to correct any inaccuracies in that information. If you have concerns about how we have used your personal information, you also have the right to complain to a privacy regulator. For detailed information, contact us on info@craigsfarm.org.uk for a copy of our Privacy Policy.

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I would like to receive information and updates on Craigsfarm Community wellbeing + resilience programme activities and Craigsfarm events

How did you hear about this service?

—Please choose an option—Bridge CounsellingBridge Financial WellbeingMy GPCommunity Psychiatric Nurse (CPN)NHS Boghall HubNHS Mental Health NurseNHS Wellbeing HubNHS St John's HospitalWest Lothian WellbeingOther community servicePoster or leafletKonect MagazineA friendA family memberOtherI attended a course beforeFacebookInstagramGoogle Search

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