The Yoga Center
Schedule
Workshops & Events
Intro to Yoga Series
Private Lessons
Teachers
Blog
About Iyengar Yoga
Contact
Places We Like
Pilates Body Shaping
Schedule
Private Sessions
Instructors
Teacher Training
Blog
About Romana's Pilates
Contact
Client Information Form
Places We Like
Pilates Body Shaping Client Information
Please fill out this form prior to attending your first Pilates class.
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number (primary)
*
-
-
Phone Number (secondary)
*
-
-
Email
*
Date of Birth
*
I am pregnant
*
Yes
No
I am a regular smoker
*
Yes
No
In the past five years I have had the following
*
Injuries
Physical ailment
Broken bones
Surgery
Muscle tension
Muscle weakness
None of the above
Details about the above
*
I am taking the following medication, nutritional suppliments, and/or vitamins
*
I currently do the following exercise on a regular basis
*
Walk
Run
Swim
Lift weights
Aerobic class
Pilates
Yoga
Martial arts
I do not currently exercise on a regular basis
Employer and Occupation
*
My hobbies are
*
I have experience with Romana's Pilates
*
Yes
No
I have studied Romana's Pilates with the following instructor(s)
*
The goals I hope to achieve by taking Pilates is
*
I heard about Pilates Body Shaping
*
Facebook
Web search
Friend/Family
Printed ad
Other
CLIENT RELEASE FORM AND CANCELLATION POLICY.
I have enrolled in a program of physical activity, including, but not limited to, body machinery used during the workouts offered by Pilates Body Shaping, Inc. I hereby affirm that I am in good physical condition and do not suffer from any disability that would contribute to injury. (OR, I have been cleared by my doctor and/or physical therapist for this Pilates program. I am not under the influence of any non-presecription drugs or alcohol. In consideration of my participation in any workshops, private workouts or group classes, I hereby release Pilates Body Shaping, Inc. and any of its teachers and/or apprentices, from any claim, demands and causes of action arising from my participation in an exercise program. I fully understand that I may injure myself as a result of my participation and I release Pilates Body Shaping, Inc. and any of its teachers and/or apprentices, from any liability now or in the future, including but not limited to: heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heart prostration, knee/lower back/foot injuries and any other illness, soreness or injury caused, occurring, during, or after my participation in the studio. Pilates Body Shaping, Inc. adheres to a strict 24-hour cancellation policy for all group and private classes. The client will not be charged if the studio is given notification of the cancellation a full 24-hours in advance. All late cancellations or no-shows will be charged. All payments are non-refundable.
I have read, understand, and agree to this Client Release Form and Cancellation Policy
*
Yes
Submit
