Student Assessment Form – Yoga in Belize – Cyril Uruwei – Yoga Teacher in Belize – 500 HOUR Certified

Cyril Uruwei – Yoga Teacher in Belize – 500 HOUR Certified

Student Assessment form

Greetings from Belize! I AM Cyril Uruwei. I will be your yoga teacher for your upcoming retreat in Belize. To ensure that you get the best experience ever, kindly take a moment of your time to complete the student assessment form below. Namaste.

500 HOUR Certified

Yoga Teacher.

Name

Country

Email

Occupation

Sedentary...

What do you do / use to alleviate stress

Age

Gender

Interested in:

Asanas (Poses/Stretching) Breathing techniques Meditation

Have you practiced yoga in the past?

How often do you practice yoga?

What motivated you to sign up for this step?

What are your primary goals for this retreat?

What other forms of exercise do you do?

How do you feel yoga could help?

What is your personal beliefs about yoga?

Have you had surgeries in the past?

Are you capable of performing exercises?

Which yoga exercises feel the most comfortable for you?

Which movements make you feel good or bad?

Please check any existing or past conditions:

High blood pressure Back/neck pain Knee pain Low blood pressure Hip pain Anxiety/depression Glaucoma Pregnancy (current) Low blood sugar

Please list any other health concerns, injuries, allergies or medical conditions

Acceptance

In any physical activity, risk of serious physical injury is possible. Yoga and other activity is no substitute for medical diagnosis and/or treatment. The student assumes the risk of yoga or other activity and releases the teacher(s) from any liability claims. I am participating in classes with Yoga Teacher, Cyril Uruwei at JAGUARUNDI Shores in Belize. I am aware of the physical risks involved with exercise and understand it is my personal responsibility to consult with my doctor regarding my participation. I have no medical conditions, that I am aware of, which would prevent me from taking part in classes or workshops, and I assume responsibility for any risk or injury I may sustain as a result of my participation. I have read the above release and waiver of liability and understand its contents. I understand that it is my responsibility to find a pace that suits me. I agree to the terms and conditions stated above.

Date