Thai Yoga Massage Online Registration Form

I would like to register for:*

Course Location*

Date of Workshop*

First and Last Name*

Address*

Suburb*

State/Province*

Post Code*

Country

Email*

Confirm Email*

Telephone/Mobile*

Registration Type*

Practice Partner

I have previous training as a movement or massage professional

no
yoga teacher
fitness instructor
personal trainer
massage practitioner
other

I am currently registered with

Yoga Australia
Fitness Australia
Yoga Alliance
IICT
Other
N/A

Safety and Accessibility

Do you have a medical or physical condition that could be made worse by a change in your physical activity?

Do you require accessibility information or support (read aloud materials, closed captioning)?

Do you have any movement restrictions/are there any movements or massage techniques that are not safe for you to give or receive or require modification or adaptation for your safety?*

Your Practice, Aims & Intentions

What you hope to gain from learning Thai Yoga Massage?*

How did you learn about this workshop?

ParQ and Informed Consent

Please tick if you answer YES to any of the following questions:

Has your doctor ever told you that you have a heart condition AND that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when not doing physical activity?
Do you lose your balance because of dizziness, or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Do you know of Any Other reason why you should not do physical activity?

I have been informed, understand and am aware that mind-body movement activities, including yoga, Pilates, and Thai yoga massage are potentially hazardous activities. I also have been informed, understand, and am aware that movement activities involve a risk of injury, and that I am voluntarily participating in these activities and using equipment with full knowledge, understanding, and appreciations of the dangers involved.

I have been informed and I consent to undertaking movement activities with an awareness of the risk involved, and I agree to modify or withdraw from any/all activities that cause/may cause discomfort

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