Client Registration

Name *

First Name

Last Name

Do you have any history of these conditions? *

High or low blood pressure

Arthritis

Osteoporosis

Disc issues

Low Blood Pressure

None of the above

Do you have any of these issues? *

Back pain

Neck Pain

Knee Problems

Hip Problems

Shoulder Problems

Elbow Problems

Wrist Problems

Foot / Ankle Problems

Scoliosis

Hypermobile Joints

None of the above

Are you currently pregnant? *

Yes

No

Have you ever participated in Pilates classes before? *

Yes, Studio Pilates

Yes, Mat Pilates

Yes, both Mat and Studio Pilates

No

Disclaimer *

To the best of my knowledge I have listed any current injuries, medical treatment that I am currently undertaking. I respect the duty of care taken by my instructor and will inform them of any medical changes in the future. I understand my instructor will observe all safety precautions but I agree to accept full responsibility for any personal injury whether caused by negligence or otherwise. As such, I understand and acknowledge that I am solely liable, responsible and accountable for my own physical well-being in the classes.

I have read and understand the above conditions and information that I have provided is correct.