Reformer Pilates Consent Form

First & Last Name

Phone

Date of Birth

Occupation

Emergency Contact (Name & Phone Number)

Have you participated in a Pilates or Reformer Pilates Class before?

Yes

Do you have any any past and/or present injuries, health concerns or medical conditions that should be known about? (e.g. Asthma, high blood pressure etc)

Do you have goals that you'd like to achieve from coming to reformer pilates?

Please list the physical exercise you participate in (e.g. running, swimming, yoga, weight training etc).

Are you currently pregnant, planning a pregnancy or less than 6 months postpartum?

If you have been referred by a friend or family member please state there name.

I would like to receive a reminder 24 hours before the session.

I agree to the Movement Studio Policy Notification?View Policy Notification

I agree and understand there is a 12 hour cancelation policy and if I cancel within this timeframe I will be charged 100% of the appointment fee.

Please sign below by typing full name and date

Thanks for submitting!