Online BH Pilates Registration Form
Please complete this form and return to
GP name and address
Do you suffer from any of the following?
Low back Pain
Pelvic girdle pain
Other spinal conditions e.g scoliosis, spondylolithesis
Breathing conditions e.g COPD, Asthma
High or low blood pressure
Any other conditions not mentioned above?
Have you had any operations or recent injuries?
Are you pregnant? If so, how many week are you?
Have you had any complications with your pregnancy? If so, please explain
Are you taking any medications? Please list them
Have you done Pilates before?
Why have you decided to do Pilates?
What is your occupation?
Does your occupation involve repetitive movements, heavy lifting or prolonged sitting?
What hobbies or sports do you do in your spare time?
Online BH Pilates participation informed consent
I declare I have read and completed the Pilates registration and health questionnaire forms correctly and to the best of my knowledge. I understand that If I have answered yes to any health questions that it is advised to seek medical advice before participating in Pilates. If I have chosen not to obtain a Doctor’s permission prior to beginning this exercise program I hereby agree I am doing so at my own risk. To the best of my knowledge I am in good physical condition and have no disease and/or condition, physical limitation, health concern or injury that would be aggravated or would be the cause of any injury sustained, before, during or as a result of online BH Pilates classes. I acknowledge that if I am pregnant it is my responsibility to seek advice from my Doctor regarding participation in exercise or physical activity. I acknowledge that the online BH Pilates program is not designed for children under the age of 16 years and that I take full responsibility for them and their actions should they choose to participate with my consent and supervision.
I understand that Pilates is generally a safe form of exercise and every effort will be undertaken to ensure I perform the exercises correctly through verbal and physical instruction. I understand that the online BH Pilates program is designed for a general group and not specifically designed as a personal Pilates plan. The online BH Pilates program will provide and demonstrate different levels of difficulty, starting at low level and progressing to more advanced levels of certain exercise elements. Therefore, I understand I have volunteered to participate in online BH Pilates classes and agree that it is my responsibility to follow these instructions and to stop the exercise element or program at any time if I am experiencing any symptoms of fatigue or discomfort or at risk of injury.
I understand that there is a risk associated with taking part in any form of exercise and that every effort will be taken to minimise these risks by the evaluation and screening from the information I have provided in this form. I am participating of my own free will. I understand it is my responsibility to inform my instructor of any current medical issues or changes to my health and the therapist/instructor shall not be liable for any and all claims, demands, damages, rights or causes of action, present and future, arising out of negligence or connected with my participation in this online program including any injuries resulting in them. I acknowledge and agree that no warranties of representations have been made to me regarding the results I will achieve from this program and results are individual and can vary. I acknowledge I have thoroughly read this waiver and release and fully understand that it is a release of liability.
I understand that I will receive access to online BH Pilates classes by invitation from BH Pilates once I have supplied this completed registration form and signed the consent statement. In order to participate in online BH Pilates classes I am required to supply payment prior to commencing the online class via PayPal.
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