Zoom Pilates Client Registration
All information is kept strictly confidential and will not be released without your authority.
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Full Name *
Email *
How old are you? *
What is your Mobile number? *
Emergency Contact details (name and mobile) *
Have you done pilates before? *
Required
Do you have or have you suffered from the following conditions (Please tick)
If you have ticked any of the above boxes, please provide further information regarding this
Is there any other conditions not listed above that should be noted
Are you pregnant or given birth in the past 12 months?
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List other forms of exercise you do or have done in the past?
What are your reasons for taking up Pilates?
• TERMS AND CONDITIONS • The Pilates program devised for you is based upon sound teaching practice and information you have provided about yourself. You must therefore inform of any changes to your medical conditions as soon as you become aware of them. If you experience any pain or dizziness during any class it is your responsibility to inform the instructor as soon as possible. All reasonable care is taken by us to ensure your safety, however you will take full responsibility for your actions in the class. In the event of an emergency, you give permission for us to seek medical attention on your behalf. Tallara Harris accepts no liability for any injury or death relating to participation in Pilates. *
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