Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Phone

(###)

###

####

Activity level *

Low

Medium

High

What are your objectives for taking up Pilates? *

Improve posture

Improve strength

Compliment other physical activities

Mindy/body wellbeing

Other

Client waiver *

I confirm that I am physically fit to participate in a Pilates group class. I understand that, as with all physical activities the risk of injury is always present and cannot be eliminated completely. If I experience any pain or discomfort, I will listen to my body and slowly, with control adjust my position and ask for support from the teacher.

Yes

No