{"id":7374,"date":"2022-02-22T12:09:37","date_gmt":"2022-02-22T12:09:37","guid":{"rendered":"https:\/\/ronayoga.co.uk\/?page_id=7374"},"modified":"2022-02-22T12:09:38","modified_gmt":"2022-02-22T12:09:38","slug":"rona-yogas-student-health-questionnaire","status":"publish","type":"page","link":"https:\/\/ronayoga.co.uk\/index.php\/rona-yogas-student-health-questionnaire\/","title":{"rendered":"Rona Yoga&#8217;s Student Health Questionnaire"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"681\" src=\"https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-1024x681.jpeg\" alt=\"\" class=\"wp-image-7375\" srcset=\"https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-24x16.jpeg 24w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-36x24.jpeg 36w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-48x32.jpeg 48w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-300x199.jpeg 300w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-768x511.jpeg 768w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-1024x681.jpeg 1024w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-1536x1021.jpeg 1536w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148.jpeg 1880w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p>Please complete the online Rona Yoga Student Health Questionnaire below. Once you have completed all relevant fields press the submit button at the end. We will receive your form and review the details that you have provided. In some situations we may have to contact you to clarify some point or to ask for further information.<br><br>You can also use this online form to inform us of any new health conditions or to update your personal information if you have moved address, changed phone number or for new emergency contact details.<\/p>\n\n\n\n<p>You can find details of our online classes on our <a href=\"https:\/\/ronayoga.co.uk\/index.php\/timetable-and-booking\/\" data-type=\"page\" data-id=\"6947\">Timetable + Booking page<\/a><a href=\"https:\/\/yogasmiths.org\/shop\/\">.<\/a><\/p>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block\" id=\"wpforms-7373\"><form id=\"wpforms-form-7373\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"7373\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/7374\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-7373-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_2\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-7373-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" required><label for=\"wpforms-7373-field_2\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7373-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" required><label for=\"wpforms-7373-field_2-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-7373-field_1-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_1\">Date of Birth<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][1][date][d]\" id=\"wpforms-7373-field_1-day\" class=\"wpforms-field-date-time-date-day\" ><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][1][date][m]\" id=\"wpforms-7373-field_1-month\" class=\"wpforms-field-date-time-date-month\" ><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][1][date][y]\" id=\"wpforms-7373-field_1-year\" class=\"wpforms-field-date-time-date-year\" ><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-7373-field_3-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_3\">Address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-7373-field_3\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][3][address1]\" ><label for=\"wpforms-7373-field_3\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-7373-field_3-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][3][address2]\" ><label for=\"wpforms-7373-field_3-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7373-field_3-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][3][city]\" ><label for=\"wpforms-7373-field_3-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7373-field_3-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][3][state]\" ><label for=\"wpforms-7373-field_3-state\" class=\"wpforms-field-sublabel after \">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7373-field_3-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][3][postal]\" ><label for=\"wpforms-7373-field_3-postal\" class=\"wpforms-field-sublabel after \">Postal Code<\/label><\/div><\/div><\/div><div id=\"wpforms-7373-field_4-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_4\">Phone<\/label><input type=\"tel\" id=\"wpforms-7373-field_4\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" ><\/div><div id=\"wpforms-7373-field_5-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_5\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-7373-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-7373-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_6\">Emergency Contact <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7373-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-7373-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_7\">Emergency Contact Phone<\/label><input type=\"tel\" id=\"wpforms-7373-field_7\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-7373-field_8-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_8\">Have you attended a Yoga Class before? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7373-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7373-field_8_1\" name=\"wpforms[fields][8]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_8_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7373-field_8_2\" name=\"wpforms[fields][8]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_8_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7373-field_9-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"9\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_9\">If Yes, how long have you practised yoga and what style of yoga have you practised?<\/label><textarea id=\"wpforms-7373-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" ><\/textarea><\/div><div id=\"wpforms-7373-field_10-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_10\">The following information is required to ensure your health. Whilst yoga may be practised safely by most people, there are certain conditions that require special attention. If you are unsure, please consult your GP before commencing class. Please indicate in the boxes below whether or not you have any of the following medical conditions and then provide further information. These following conditions require specific modifications to your yoga practice:<\/label><ul id=\"wpforms-7373-field_10\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_1\" name=\"wpforms[fields][10][]\" value=\"Abdominal disorder or recent surgery\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_1\">Abdominal disorder or recent surgery<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_2\" name=\"wpforms[fields][10][]\" value=\"Joint replacement\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_2\">Joint replacement<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_3\" name=\"wpforms[fields][10][]\" value=\"Heart disorders\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_3\">Heart disorders<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_4\" name=\"wpforms[fields][10][]\" value=\"Arthritis (osteo or rheumatoid)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_4\">Arthritis (osteo or rheumatoid)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_5\" name=\"wpforms[fields][10][]\" value=\"Knee problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_5\">Knee problems<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_6\" name=\"wpforms[fields][10][]\" value=\"High blood pressure\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_6\">High blood pressure<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_7\" name=\"wpforms[fields][10][]\" value=\"Unspecified back pain \/ problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_7\">Unspecified back pain \/ problems<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_8\" name=\"wpforms[fields][10][]\" value=\"Hip problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_8\">Hip problems<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_9\" name=\"wpforms[fields][10][]\" value=\"Low blood pressure\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_9\">Low blood pressure<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_10\" name=\"wpforms[fields][10][]\" value=\"Spinal injury\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_10\">Spinal injury<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_11\" name=\"wpforms[fields][10][]\" value=\"Shoulder or neck problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_11\">Shoulder or neck problems<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_10_12\" name=\"wpforms[fields][10][]\" value=\"Other - please specify\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_10_12\">Other &#8211; please specify<\/label><\/li><\/ul><\/div><div id=\"wpforms-7373-field_11-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_11\">Further Information<\/label><textarea id=\"wpforms-7373-field_11\" class=\"wpforms-field-small\" name=\"wpforms[fields][11]\" ><\/textarea><\/div><div id=\"wpforms-7373-field_12-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_12\">Additional Conditions<\/label><ul id=\"wpforms-7373-field_12\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_4\" name=\"wpforms[fields][12][]\" value=\"Asthma\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_4\">Asthma<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_5\" name=\"wpforms[fields][12][]\" value=\"Anxiety \/ depression\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_5\">Anxiety \/ depression<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_6\" name=\"wpforms[fields][12][]\" value=\"Epilepsy\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_6\">Epilepsy<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_7\" name=\"wpforms[fields][12][]\" value=\"Respiratory issues\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_7\">Respiratory issues<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_8\" name=\"wpforms[fields][12][]\" value=\"Sensory disorder affecting eyes or ears\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_8\">Sensory disorder affecting eyes or ears<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_9\" name=\"wpforms[fields][12][]\" value=\"Diabetes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_9\">Diabetes<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_10\" name=\"wpforms[fields][12][]\" value=\"Auto-immune disorder (e.g. M.E., M.S., Lupus, etc.)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_10\">Auto-immune disorder (e.g. M.E., M.S., Lupus, etc.)<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_11\" name=\"wpforms[fields][12][]\" value=\"Balance affecting disorder\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_11\">Balance affecting disorder<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_12\" name=\"wpforms[fields][12][]\" value=\"Migraine\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_12\">Migraine<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_12_13\" name=\"wpforms[fields][12][]\" value=\"Other - please specify\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_12_13\">Other &#8211; please specify<\/label><\/li><\/ul><div class=\"wpforms-field-description\">These conditions may affect your practice and so it will be useful for your tutor to be aware of them<\/div><\/div><div id=\"wpforms-7373-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_13\">Further Information<\/label><textarea id=\"wpforms-7373-field_13\" class=\"wpforms-field-small\" name=\"wpforms[fields][13]\" ><\/textarea><\/div><div id=\"wpforms-7373-field_14-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_14\">Please tick in this box if you do not wish to declare medical information. Please be aware that your yoga teacher cannot give any modifications or alternatives that may be appropriate, for conditions that have not been declared.<\/label><ul id=\"wpforms-7373-field_14\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_14_1\" name=\"wpforms[fields][14][]\" value=\"I do not wish to declare medical information\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_14_1\">I do not wish to declare medical information<\/label><\/li><\/ul><\/div><div id=\"wpforms-7373-field_17-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_17\">Have you had any recent operations (in the last two years)? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7373-field_17\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_17_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][17][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_17_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][17][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_17_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7373-field_18-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"18\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_18\">If Yes, please provide further information<\/label><textarea id=\"wpforms-7373-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/textarea><\/div><div id=\"wpforms-7373-field_20-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_20\">Are you \/ could you be, pregnant, or have you given birth in the last six weeks? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7373-field_20\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_20_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_20_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_20_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7373-field_21-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"21\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_21\">If Yes, please provide further information<\/label><textarea id=\"wpforms-7373-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/textarea><\/div><div id=\"wpforms-7373-field_22-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_22\">Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other? How regularly do you do this?<\/label><ul id=\"wpforms-7373-field_22\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_22_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][22][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_22_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][22][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_22_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7373-field_23-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_23\">If Yes, please provide further information<\/label><textarea id=\"wpforms-7373-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/textarea><\/div><div id=\"wpforms-7373-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_24\">How did you hear about this class?<\/label><input type=\"text\" id=\"wpforms-7373-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><\/div><div id=\"wpforms-7373-field_26-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_26\">Disclaimer &#8211; tick the box to confirm your understanding and acceptance of our disclaimer * <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7373-field_26\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_26_1\" name=\"wpforms[fields][26][]\" value=\"I confirm my understanding and acceptance of this health questionnaire and its disclaimer\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_26_1\">I confirm my understanding and acceptance of this health questionnaire and its disclaimer<\/label><\/li><\/ul><div class=\"wpforms-field-description wpforms-disclaimer-description\">Please take care when filling in this questionnaire and check the contents are accurate before you submit it. By submitting the questionnaire, you are confirming that the contents are true and accurate to the best of your knowledge. Please notify your teacher of any changes to your responses in this healthcare questionnaire before participating in classes subsequent to those changes.<br \/>\r\nNeither your teacher nor the British Wheel of Yoga are qualified to express an opinion that you are fit to safely participate in any British Wheel of Yoga organised sessions or any British Wheel of Yoga trained teacher\u2019s yoga classes. You must obtain professional or specialist advice from your doctor before participating if you are in any doubt.<br \/>\r\nAll of our yoga instructors are appropriately qualified or British Wheel of Yoga Accredited teachers, with high standards of teaching and best practice. Where possible, your teacher may offer suitable modifications or adjustments and practices to suit different levels of experience and ability.<br \/>\r\nPlease always let the teacher know before the class if this is your first time practicing yoga or if you are not confident about your experience and\/or ability. Where you are taking part in live-streamed classes, please note that the instructor may not be able to see you at all times. Where you have declared a health condition, please contact the teacher before the class if you would like to request that you are provided with suitable modifications or adjustments wherever possible. Please note, where you are taking part in a pre-recorded class, you will not be able to request specific adjustments or modifications.<br \/>\r\nIn all classes whether face to face, live streamed remote or pre-recorded remote, always follow your teacher\u2019s safety instructions and listen to your body. Where a movement or class is beyond your experience or ability, feels too difficult for you, or you experience any discomfort, please do not continue the movement or class.<\/div><\/div><div id=\"wpforms-7373-field_27-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_27\">Date Completed<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-7373-field_27\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-input=\"true\" name=\"wpforms[fields][27][date]\" placeholder=\"DD\/MM\/YYYY\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-7373-field_28-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-7373-field_28\">GPDR Statement:<\/label><ul id=\"wpforms-7373-field_28\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_28_1\" name=\"wpforms[fields][28][]\" value=\"Email\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_28_1\">Email<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_28_2\" name=\"wpforms[fields][28][]\" value=\"Post\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_28_2\">Post<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-7373-field_28_3\" name=\"wpforms[fields][28][]\" value=\"Telephone\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7373-field_28_3\">Telephone<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Please tick any of the above boxes to confirm how you wish to be contacted in future and to confirm you are happy for me to retain your contact details for the reasons and in the manner detailed below.  \r\n\r\nIn order to comply with the General Data Protection Regulations, it is necessary for me to check whether or not you are happy for me to retain your contact details, and to send you information that I think may be useful to you, including training and events, and relevant updates. I only hold information when it is necessary to do so in order for me to carry out my work, and when you have given me permission to do so. To ensure that I only communicate with you in the manner of your preferred choice, please will you indicate below, your agreement, or otherwise, to the above suitable means of communication:<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"7373\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><input type=\"hidden\" class=\"wpforms-token\" name=\"wpforms[token]\" value=\"a12b31ca72f0b234a3c72621735866f3\" \/><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-7373\" class=\"wpforms-submit button\" data-alt-text=\"Sending\u2026\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/ronayoga.co.uk\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"681\" src=\"https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-1024x681.jpeg\" alt=\"\" class=\"wp-image-7375\" srcset=\"https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-24x16.jpeg 24w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-36x24.jpeg 36w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-48x32.jpeg 48w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-300x199.jpeg 300w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-768x511.jpeg 768w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-1024x681.jpeg 1024w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148-1536x1021.jpeg 1536w, https:\/\/ronayoga.co.uk\/wp-content\/uploads\/2022\/02\/document-agreement-documents-sign-48148.jpeg 1880w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p>This Rona Yoga Student Health questionnaire is based on the British Wheel of Yoga Student Health Questionnaire. You can find further details about the British Wheel of Yoga on their website at&nbsp;<a href=\"https:\/\/www.bwy.org.uk\/\">https:\/\/www.bwy.org.uk\/<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"important-notice-for-online-classes\"><strong>IMPORTANT NOTICE<\/strong>&nbsp;\u2013 for online classes<\/h4>\n\n\n\n<p>Although there are tremendous benefits to overall health and wellbeing, yoga can be physically challenging. It carries with it risks that cannot entirely be eliminated.&nbsp; These include the risk of personal injury. The exacerbation of existing injuries or conditions. And also damage to property around you during your participation.<\/p>\n\n\n\n<p>Please note that although you may appear on video link during the live stream of the class, the instructor may not be able to see you clearly or instruct you individually as is possible in a face to face teaching scenario.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Please complete the online Rona Yoga Student Health Questionnaire below. Once you have completed all relevant fields press the submit button at the end. We will receive your form and review the details that you have provided. In some situations we may have to contact you to clarify some point or to ask for further &hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","jetpack_post_was_ever_published":false,"footnotes":""},"acf":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/P9kYL0-1UW","jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/pages\/7374"}],"collection":[{"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/comments?post=7374"}],"version-history":[{"count":2,"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/pages\/7374\/revisions"}],"predecessor-version":[{"id":7377,"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/pages\/7374\/revisions\/7377"}],"wp:attachment":[{"href":"https:\/\/ronayoga.co.uk\/index.php\/wp-json\/wp\/v2\/media?parent=7374"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}