Registration FORM - 21 Days - 21 Minutes Challenge

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Personal Details

Name*

Surname*

Age*

Gender*

Phone number*

Address*

Emergency contact name, relationship, and phone number*

General Info

How did you come to know about this program?*

Please give details of yoga or meditation you have practiced and how long you have been practicing.*

Have you learnt any other Isha Yoga practices?

If yes, please give details below:

Health Information

In case of any health condition, this information can help us adapt the classes to your personal needs. This information is confidential. If required, we can also discuss your personal needs in more detail on the phone.

Other

Please give details of the nature and duration of the condition and if you are currently undergoing any treatment:*

Please indicate below if you currently or previously have had any physical or mental ailments*

For women: Are you currently pregnant?

Have you had any surgery in the last six months?

Agreement

I hereby willingly undertake to attend this program completely. I take full responsibility for the result and indemnify the organizers against all claims and suits. I will not communicate the contents of the program, either directly or indirectly, to anyone else. I understand the participation guidelines and agree to follow them. I hereby declare that the above information is true, accurate, and complete to the best of my knowledge.*

Yes

Any other information

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