Please print this page, fill out the form and bring it with you to your first class.
First and last name ________________________________________________________
Email address Home _______________________________________
Work (optional) __________________________________________
Telephone number Home ___________________
Work (optional) __________________________
Mobile (optional) _________________________
Profession/type of work ______________________
Date of birth ____________________
Class(es) you are interested in:
Pilates Mat Classes
Level: Beginner Intermediate Advanced
Number of classes per week - One or Two
Active in other sports _____________________________________________________
Stabilized? ___________When? _______________
Stabilized? ___________________When? ____________________
Any physical limitations advised by healthcare professionals? yes no
If so, what are the limitations, advised by whom?
How did you hear of PilatesforeveryBody _____________________________________
Your signature on this form confirms that this information sheet has been truthfully completed by you. You agree that you participate in the lessons at your own risk and that Loretta Simon Helms and other instructors and lessors of premises where the lessons are held are in no event liable for any damage or injury you may incur.
Privacy Protection. This information will be used to identify you to other instructors of Pilates and to advise you on developments on Pilates. It will not be given to any third parties.