Statement of participation in Prenatal Yoga Classes

Name: __________________________________________________

Address: ________________________________________________________

Date of Birth: _____________________________________________

I declare that:

• I am in my 14th week of pregnancy and I am participating in pregnancy yoga classes with the approval of my doctor.

• I do not have deep vein thrombosis.

• I do not have chronic migraines.

• I do not have high blood pressure.

• I do not have vaginal bleeding.

• I do not have a hernia.

• I do not have chronic edema symptoms in my hands and legs.

• I do not have an anterior placenta.

I declare that if any changes occur in my condition during pregnancy, I will inform the yoga instructor.

If I notice any of the above symptoms, I will not participate in the yoga class.

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