SURNAME*

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FORENAME(S)*

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DATE OF BIRTH*

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E-MAIL*

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ADDRESS*

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TELEPHONE NUMBER*

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What are your health goals and what are you looking to achieve from Pilates?*

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NEXT OF KIN*

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Have you previously experienced or do you currently experience any of the following:

Lower back pain

Joint pain

Spinal issues

Cancer

Stroke

Abnormal blood pressure

Heart attack

Neurological conditions

Depression

Diabetes

Epilepsy

Osteoporosis

Osteopenia

Are you pregnant?

Knee or hip replacement

Are there any other reasons why you should not participate in exercise? If you are unsure please check with your GP

Have you been involved in any accidents, or sustained broken bones or damaged ligaments/tendons?

Do you have any other health related issues that we should know about?*

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Disclaimer: I acknowledge that participation in these classes is at my own risk and that the studio or instructor will not be held liable for injuries which may be sustained.*

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I confirm that I will not attend the studio if I have any COVID 19 symptoms, or have been in close contact with someone who is COVID positive.*

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I agree to pay the full class fee in the event that I give less than 24 hours cancellation notice*

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I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

* Indicates required fields

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Thank You! We look forward to welcoming you to the studio.