Pilates Registration Form

Please complete this registration form.


YOUR DETAILS

Male Female


PILATES AIMS


LIFESTYLE


HEALTH QUESTIONNAIRE


1. Please tick any of the following conditions that you have been diagnosed with or have had treatment for. Please give details.

2. Have you or are you currently experiencing any of the following conditions? If yes, please give details.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No


3. Are you allergic to latex or anything else? If yes, please give details.

Yes No


4. Are you pregnant? If yes, please say how many weeks you are and describe any complications with your pregnancy.

Yes No N/A


Pilates Participation Informed Consent

The Pilates programme will begin at a low level and will be advanced in stages depending on your fitness level. We may stop the exercise session because of signs of fatigue or excessive strain. It is important for you to realise that you may stop when you wish because of feelings of fatigue or any other discomfort.

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. Every effort will be made to minimise these risks by evaluation of preliminary information relating to your health and fitness and by observations during exercising.

I understand that the Pilates programme will be specifically designed as a personal training plan, and will take into account details given in my health questionnaire. Therefore, this programme of exercise should only be undertaken when in a Pilates class, or when I have been given specific instructions to exercise on my own.

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