New Student Intake Form: Please fill out and submit prior to your first class

Name

First Name

Last Name

Age

Preferred Pronouns

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact + Phone number

Referred by:

Please briefly describe your experience with the Feldenkrais method:

Are you recovering from an injury or chronic pain? If so, please explain. Please include what resting positions are comfortable or not.

Please explain any physical or mental health history that you feel important for me to know:

Is there anything else you would like me to know about you?

I understand that Yoga and the Feldenkrais Method incorporate both cognitive and physical approaches, and that there is an inherent risk when participating in physical activities. I agree to let Sarah know of any physical limitations I might have, or any physical activities I do not wish to participate in. I hereby release Sarah Baumert, Sarah B. Yoga, Inc., BODY MATTER and all other sponsoring agencies from responsibility for any injuries I may sustain as a result of participation in this program. 

I agree