ENROLLMENT FORM

Personal Information

First name

Last name

Phone

Emergency Contact Name and Phone Number

Health Information

Do you have any injuries/pathologies?

Any previous surgeries?

Are you pregnant or have you given birth in the last 12 months?

Are you taking any medication?

Do you have any issues with blood pressure?

Do you have any previous Pilates experience?

Do you take part in any other physical activities?

Why have you decided to try Pilates? Do you have any specific goals to work on (e.g. mobility, strength etc)?

Disclaimer

I understand various risks are associated with an exercise programme and it is my desire to participate.

I have not withheld any relevant information regarding my physical condition, which may affect my health or ability to participate. I will inform my instructor immediately if I feel any discomfort, before during or after sessions.

I acknowledge and consent that the instructor may need physical contact with me in order to correct my exercise techniques or otherwise provide instruction, if at any time I am uncomfortable with an instructors physical contact, I agree to express my preference to forego the instructional benefit of such contact.

I agree that the instructor is not responsible for any injuries, disabilities, loss or damages sustained by myself during my sessions. I hereby release the instructor Genevieve Cummings and if applicable, owners and lessors of premises used to practice from any responsibility.

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