Online private yoga registration form
Please fill in the form below to register for your Online Private Yoga.
*mandatory fields.
About me
First Name
*
This field is required
Last Name
*
This field is required
I am a PURE Cardholder
*
Yes
No
This field is required
Cardholder Number
*
This field is required
Mobile number
*
This field is required
Email
*
This field is required
Is this your first time practising yoga?
*
Yes
No
This field is required
How long have you had a consistent yoga practice?
*
Less than 6 months
6 months to 1 year
1 to 3 years
3 to 5 years
More than 5 years
This field is required
Are you currently a member of another yoga studio or fitness centre?
*
Yes
No
This field is required
Do you have any medical or physical conditions that may prevent you from engaging in physical exercise?
*
Yes
No
This field is required
Do you currently have any injuries?
*
Yes
No
This field is required
If you are female, are you currently pregnant?
*
Yes
No, N/A
This field is required
How many weeks into your pregnancy?
*
Are you currently exercising or practising yoga regularly?
*
Yes
No
This field is required
How often?
*
This field is required
Action plan
What are your primary interests and/or yoga goals for taking Online Private Yoga classes? You can choose more than one option.
*
Lose weight
Reduce stress
Increase energy
Tone & firm
Sleep better
Rehabilitate injury
Increase flexibility
Build muscle and increase strength
This field is required
What is your preferred schedule for the Online Private Yoga classes? You can choose more than one option.
*
Morning
Lunchtime
Afternoon
Evening
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
This field is required
What are your preferred time slots? You can choose more than one option.
*
6am-9am
9am-12pm
12pm-2pm
2pm-6pm
6pm-9pm
This field is required
Please also list what country you are in for time zone considerations
*
This field is required
What is the total number of classes you wish to have per week?
*
1 to 2
3 to 4
5 or more
This field is required
Which gender would you prefer for your Pure Yoga teacher?
*
Male
Female
No preference
This field is required
Please pick your preferred language of instruction. You can choose more than one option.
*
Mandarin
Cantonese
English
This field is required
Any other important information you would like to provide for your Online Private Yoga classes?
*
This field is required
If you already have a preferred teacher, please let us know their name. Otherwise, we will find a suitable teacher based on your provided information. Please note that not all Pure Yoga teachers are available for Online Private Yoga
*
This field is required
Submit