Parent's Name:______________________________________________________
Parent's Address:_____________________________________________________
City: ___________________________State: ______________Zip: _____________

I consent to the above named patient's participation in the Pacific Grove Adult Education, Parents' Place Pre/Post Natal Yoga program. Pre-Natal Yoga is designed for the special needs of the pregnant woman.
Poses stretch, strengthen and open to provide for a more comfortable pregnancy and prepare for labor and delivery. Classes are composed of body, mind and spirit to support the demands of the childbearing year.

Without poses on the belly and few poses on the back, prenatal yoga allows mothers to gain more comfort with less nerve impingement in the groin and less swelling in joints because of the gentle stretching. Pre-Natal Yoga poses open and stretch the pelvis to make for more comfortable childbearing.

Post-Natal Yoga is designed for moms with their pre-crawling infants. Mothers can come with their newborns, 4 weeks after delivery or after bleeding. Post-Natal Yoga is careful of the post-natal body, working to tone the abdomen slowly and gently. Also, it strengthens the body, helps regain energy and calms the mind.

Physicians' Signature: _________________________________ Date: ___________________

_____________________________________________________________________________

Physicians Name (PLEASE PRINT)

This completed form can be faxed to Parents' Place at  831-641-9346