PHHC Intro to Yoga Workshop Questionnaire
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Thank you for registering for our Introduction to Yoga Workshop taking place on Saturday, January 21, 2012, from 2-4 pm.
To make this workshop an even more worthwhile experience for you, please complete this short questionnaire.
*
1
. Please provide some basic contact information for the person attending this workshop.
Please provide some basic contact information for the person attending this workshop.
Name:
Email Address:
Phone Number:
2
. How did you learn of our event?
How did you learn of our event?
Website (Pacific Heights Health Club or Flow Studios)
Newsletter
Posters
Social Network (Facebook, Twitter, etc.)
Friend
While passing the event location
Other (please specify)
3
. Have you ever taken a yoga class before?
Have you ever taken a yoga class before?
No, I have not taken a yoga class before.
Yes, I have taken a yoga class before.
Please add how long ago and/or how often.
4
. Do you have a daily/weekly exercise regime?
Do you have a daily/weekly exercise regime?
No, I don't have a daily or weekly exercise regime.
Yes, I have a daily/weekly exercise regime.
My routine consists of the following:
5
. Have you had any major illness and/or surgery in the last six months?
Have you had any major illness and/or surgery in the last six months?
No
Yes
Please describe below. We will keep this information private.
6
. Are you currently pregnant or have you given birth in the last three months?
Are you currently pregnant or have you given birth in the last three months?
No
Yes
7
. Are there any pre-existing long-term ailments or injuries that may prevent you from certain movement or exercise?
Are there any pre-existing long-term ailments or injuries that may prevent you from certain movement or exercise?
No
Yes
If yes, please describe below. We will keep this information private.
8
. What is the purpose/intent for (you) taking this workshop? Check all that apply.
What is the purpose/intent for (you) taking this workshop? Check all that apply.
Fitness / health
Mental peace and serenity
Spiritual
Just for fun
All of the above
Other
Thank you for taking the time to complete this survey.
We look forward to seeing you at our Introduction to Yoga Workshop on Saturday, January 21, 2012
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