Application for Advanced Contrology Program 2024 NYC August / December
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Full Name *
Birthday *
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Address *
Email *
Cell Phone *
Are you on WhatsApp
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Education Degree (if applicable)
Pilates Certification Institution *
Pilates Certification Graduation Date  *
Other Pilates Certifications
Other continuing education programs
How many hours a week do you teach? *
How many years have you been teaching? *
Do you have your own studio? *
Where do you teach Pilates? *
Why are you interested in taking the Advanced Contrology Program with Inelia Garcia? *
Describe yourself in a few words. (Your journey with Pilates, your current lifestyle...) *
What are your expectations with this course? *
What are your personal desires with this course? *
Have you had any surgeries or injuries recently? *
Are you currently injured or suffering from an illness that effects your movement in any way? *
Are you taking any medications? *
Please list any medications that you are taking *
Do you smoke or vape?
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What is your height and weight?
What forms of exercise are you practicing these days? *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact relationship to you *
In case of any emergency, you may be taken to the closest hospital  *
I understand and have completed this form to the best of my knowlegde. 

I am physically fit to perform the exercises in the program. 

If there is anything that I feel I am not suited to perform, I will remove myself from the exercise and notify the teacher. 

I understand that there are risks involved in this program and I take full responsibility for myself. I will act with caution and common sense throughout the program.

Please enter your full name below as a signature affirming the above statement.
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