Pilates Intake sheet
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1.0 Name (Last, first) *
2.0 How did you hear about our studio?  We like to thank our referrals! *
3.0  Can we contact you via email?  This is for new classes and schedules, not to send spam.   *
4.0  If you answered "Yes" to 3.0, what is the best email address to reach you? *
5.0 Phone Number (only to be used to reach you for class cancellation) *
6.0  Address *
7.0 Do you have any injuries, aches, or pains? (recent or old)  Please describe them.   *
8.0 Do you have any health concerns? Ex. asthma, diabetes, high blood pressure, medications? *
9.0  Are you currently receiving other kinds of therapy?   *
Required
10.0  Have you participated in any exercise programs or physical activity within the last 6 months? *
11.0  Which class have you registered for? *
12.0  Waiver of Liability - In consideration for being allowed to participate in the activities and programs hosted by Absolute Pilates, I do hereby waive and forever discharge Absolute Pilates and its employees from any and all responsibility from injuries or damage resulting from my participation in any activities or use of equipment.  By clicking Yes you agree that you have read and understood the above statement.   *
13.0 Waiver of Liability - I understand that fitness activities involve a risk of injury and that I am voluntarily participating in these activities and using equipment with knowledge of the dangers involved.  I hereby agree to expressly assume and accept any and all risk of injury.  By clicking Yes, you agree that you have read and understood this statement.   *
14.0  Waiver of Liability - I acknowledge that I have either; had a physical examination and been given my physician's permission to participate or I have decided to participate in activities hosted by Absolute Pilates without approval of my physician.  I do hereby assume all responsibility for my participation in activities hosted by Absolute Pilates.   By clicking Yes you agree that you have read and understood this statement.   *
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