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CLIENT REGISTRATION FORM
Kindly complete the client registration form . 

We will reach out to you via WhatsApp within 3 business days to book your appointment. 
Family Name *
Email *
Date of birth *
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Gender *
Address *
Whatsapp phone number *
What is your preferred time slot for your session? Please choose all that apply to you.  

If you have specific time slots in mind, please choose "Other" and note down the time (s)
 *
Required
Have you done pilates before? *
Required
If you have done pilates before, how long have you been doing pilates and at which studios ?

If you have never done pilates, please indicate NA. 
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Have you done Gyrotonic before? *
Required
If you have done Gyrotonic before, how long have you been doing Gyrotonic and at which studios ?

If you have never done Gyrotonic, please indicate NA. 
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Have you done Gyrokinesis before?
If you have done Gyrokinesis before, how long have you been doing Gyrokinesis and at which studios ?

If you have never done Gyrokinesis, please indicate NA. 
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Emergency contact

Name:
Number:
Relation to you:
 *
Do you have any of the following pre-existing health conditions, issues & surgeries ? Click on all that apply to you *
Required
If you clicked on "Other" in the above question, please elaborate on the condition below. 

If you would also like to further elaborate on any of the conditions "clicked" on in the above question, please do so below. 

If there is nothing to elaborate, please indicate NA.
 *
Do you have any injuries? If so, please elaborate below.

If you have none, please indicate NA.
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Are you pregnant? *
If you are pregnant, pls note down how many months you have been pregnant.

Otherwise, please indicate NA.
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What physical activities do you engage in? (e.g. walking , running, swimming, strength training, etc) *
What are your fitness goals, if any? *
Why are you interested to do pilates and how do you think pilates can help you? *
1. Acceptance of Liability and Waiver of Liability 

In consideration of Balanced Movement Ventures (JR0144217-V) (known as "Balanced Movement") providing classes, courses, workshops, bodywork, physiotherapy and rehabilitation sessions (known as “Session/s”) to you, you and your heirs, next-of-kin, personal representatives and assigns (collectively known as your “Legal Representatives”), hereby agree as follows: 


To waive all claims that you have or may have in future against Balanced Movement , its affiliates, its teachers, therapists, employees, contractors and agents; to the extent permitted by law, to release and forever discharge Balanced Movement, its affiliates, teachers, therapists, employees, contractors and agents from all liability for all personal injury, death, property damage and other loss resulting from your participation in Sessions due to any cause, including but not limited to negligence, breach of any duty imposed by law, breach of contract or mistake or error of judgement of Balanced Movement, its affiliates, teachers, therapists, employees, contractors and agents; to be liable for and to hold harmless and indemnify Balanced Movement, its affiliates, teachers, therapists, employees, contractors and agents from all actions, proceedings, claims, damages, costs demands including court costs, and legal costs and liability of whatsoever nature or kind arising out of or in any way connect with your participation in Sessions or any injury/damage sustained any person accompanying you during your Sessions; that Balanced Movement, its affiliates, teachers, therapists, employees, contractors and agents shall not be liable for any loss or damage to your belongings which shall be left at its premises at your own risk. 

Balanced Movement assumes no liability for injuries/ accidents and/ or damage occurring during your Sessions. Each participating individual, including all Legal Representatives, is aware that Sessions involve physical activity and exertion and therefore are at your own risk, and accept full responsibility for any injury, loss or damage to themselves or their property. 

2. Insurance

Each participating individual, including all Legal Representatives, is personally responsible for having adequate insurance coverage.


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