Please complete and submit the form. Thank you. * denotes required information.
First Name*
Last Name*
Address line 1*
address line 2
Town*
Postcode*
Date of birth*
Your Email*
Contact Number
Have you done Pilates before and when?
Do you have any pain in the following areas?
HipsBackKneesAnklesNeckShouldersElbows
Other
Please expand on location of pain and limitations
Have you had any surgery?
Please confirm any of the following conditions that you have been diagnosed with or have had treatment for.
AsthmaDiabetesHigh/Low blood pressureOsteoporosisHeart problemsCancerEpilepsyStroke
The Pilates programme will begin at a low level and will be progressed however if you feel fatigue or discomfort you must stop and take a break. There exists the possibility of certain dangers when exercising. They include abnormal blood pressure, fainting, irregular, fast or slow heart rhythm and in rare instances, heart attack, stroke or death. Whilst every care will be taken, it is impossible to predict the body’s exact response to exercise. I am aware of the risks in participating in this class and I understand that my participation in this class is entirely at my own risk. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of those risks even if injuries occur in a manner that is not foreseeable at the time I sign this agreement.
I have read and understand the terms of the privacy policy.
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