enrollment form Personal DetailsName(Required) First Last Email(Required) Enter Email Confirm Email Background & HealthWhat is your occupation? What hobbies do you enjoy? Does your work/sport involve any of the following? Sitting for long periods Driving Bending Lifting heavy weights Standing Any other repetitive action Will this be the first time that you have practised Pilates?(Required) Yes No If yes, number of classes attended:(Required) 0-5 5-10 10-20 20+ Has your doctor ever said that you have any sort of heart trouble or defect?(Required) Yes No Do you feel pain in your chest when you undertake physical activity?(Required) Yes No Are you, or could you be pregnant now?(Required) Yes No Have you been pregnant in the last six months?(Required) Yes No Do you often get headaches?(Required) Yes No How is your blood pressure?(Required) High Normal Low Please let us know of any blood pressure medications: Do you experience fainting, dizziness, or have you lost conciousness when exercising?(Required) Yes No Have you had major surgery in the past 10 years?(Required) Yes No Have you had minor surgery in the past 2 years?(Required) Yes No Do you suffer from asthma, diabetes, or epilepsy?(Required) Yes No Have you ever been told that you have arthritic joints, osteoporosis, or any bone or joint problem that may be made worse by exercise?(Required) Yes No Do you suffer from neck or back pain?(Required) Yes No Do you have pain or restricted movement in any other joints (e.g. hip, knee, ankle)?(Required) Yes No Have you been diagnosed as hypermobile (excessive joint mobility)?(Required) Yes No Are there any movements that cause you pain?(Required) Yes No Please explain... Have you been referred to Pilates by a specialist?(Required) Yes No If yes, by your: GP Chiropractor Physiotherapist Osteopath Other Do you hereby give us permission to contact them?(Required) Yes No If yes: Practitioner's Name Phone Number Please list any health problems you suffer, not already mentioned, or that may affect your ability to exercise. If you have answered YES to any of the questions above, we advise that you consult with your medical practitioner before you start Pilates classes. Please give further relevant details, in confidence, to any questions ticked YES below.Your GoalsWhat are your reasons for taking up Pilates? What health or physical goals would you like to achieve over the next three months? What longer-term health or physical goals would you like to achieve over the next 12 months? Important InformationPlease advise us before commencing any session if, for any reason, your health or your ability to exercise changes. It is inadvisable to do Pilates between weeks 8 to 14 of pregnancy, unless by special arrangement with your teacher. It is also wise to wait six weeks after the birth before resuming exercise. Pilates exercises are very safe, however, as with all forms of physical exercise, it is prudent to consult your doctor before starting Pilates sessions. These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner. The teacher can accept no liability for personal injury related to participation in a session if: • Your doctor has, on health grounds, advised you against such exercise; • You fail to observe instructions on safety or technique; • Such injury is caused by the negligence of another participant in the class/studio. Exercise should be performed at a pace which feels comfortable to you. PAIN is the body's warning system and should NOT BE IGNORED. Please inform your teacher immediately if you feel any discomfort during a session. Please also inform the teacher if you felt any discomfort after a previous session. I understand that The Pilates Tree exercises involve hands-on correction and I hereby consent for my teachers to work in this way.LIABILITY WAIVERTo the best of my knowledge, I am in good physical condition and fully able to participate in this Pilates course. I am aware that with any type of physical activity there are risks and hazards connected with the participation. I hereby voluntarily participate in said event, knowing that the associated physical activity may be hazardous to my property and me. I voluntarily assume full responsibility for any risks or loss, property damage, or personal injury, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this course. I hereby release, waive, discharge and covenant not to sue Christine Waterman or The Pilates Tree Studio, their officers, servants, agents, and instructors (herinafter referred to as releasees) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the even is being conducted. It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a release, waive, discharge, and convention to sue the above named releasees. In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed; no oral representations, statement or inducements, apart from the foregoing written agreements have been made; and I execute this release for full, adequate and complete consideration fully intending to be bound by same. I will not advertise that I have been formally certified by Christine Waterman or The Pilates Tree and acknowledge that I am not certified to teach Pilates.Your doctor has, on health grounds, advised you against such exercise; You fail to observe instructions on safety or technique; Such injury is caused by the negligence of another participant in the class/studio.CANCELLATION POLICYCancellation of an Appointment: In order to be respectful of studio policies, please contact the studio if you are unable to attend a session. We ask that you give us a minimum of 24 hours notice prior to your start time. This will give us some time to offer your spot to another person. How to Cancel Your Appointment: To cancel appointments, please email us at info@thepialtestree.com or call 250-320-2639 and leave a message is we are unable to answer. Late Cancellations: Late cancellations will be considered as a "no show". You will be automatically charged for the class.Terms of Use Privacy PolicyConsent(Required) I agree to terms of use and privacy policy. I have read and understood the waiver and cancellation policies.Name First Today's Date MM slash DD slash YYYY CAPTCHA
