New Client Registration Form

Please complete the below form to register as a new client at Hara Beyond Movement Studio Coffs Harbour. Once we have reviewed this form we will contact you for an Initial consultation so we can help you find the classes which will best fit your needs.

First Name *
First Name
D.O.B
D.O.B
Optional
May we send you emails?
Phone *
Phone
May we send you texts? *
Emergency Contact Phone *
Emergency Contact Phone
Medical History
Are you pregnant?
Please inform Hara Studio if you become pregnant so we can modify exercises for you.
When are you due?
When are you due?
May we use hands on techniques with you? *
May we take photos / video of you for social media? *