PERSONAL INFORMATION

Name *

First

Last

Age *

Contact Number *

Email *

Occupation *

Hobbies and Sports *

YOUR HEALTH AND BACKGROUND

1. Will this be the first time you have practised Pilates? *

YES
NO

2. Do you have any medical conditions and or Injuries that prohibit exercise? *

YES
NO

If yes, please give more detailed information in the next box.

3. Have you ever been told by your doctor that you cannot exercise? *

YES
NO

4. Are you currently pregnant? *

YES
NO

5. Have you given birth in the last six months? *

YES
NO

6. If you have answered ‘YES’ to any question 2-5, do you have medical permission to exercise?

YES
NO

7. Do you have restricted movement in any of your joints? (e.g. Hip, Knee, Wrist) *

YES
NO

8. Are there any movements that cause you pain? *

YES
NO

If ‘YES’ to question 7-8 please detail below.

9. Are there any other reasons your ability to exercise may be affected? *

YES
NO

If ‘YES’ please detail below.

10. Have you been recommended to take up Pilates by a specialist practitioner? *

YES
NO

If ‘YES’ by who?

11. Do you give me permission to contact them?

YES
NO

Practitioner Name:

Practitioner Contact Number:

Please list below any health problems not already mentioned, that may affect your ability to exercise.

Emergency Contact Name and Relation

Emergency Contact Number

IMPORTANT INFORMATION

These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner.

The teacher can accept no liability for personal injury related to participation in a session if:

• Your doctor has, on health grounds, advised you against such exercise

• You fail to observe instructions on safety or technique

• Such injury is caused by the negligence of another participant in the class/studio

Exercise should be performed at a pace which feels comfortable for you. Pain is the body’s warning system and should not be ignored. Please inform your teacher immediately if you feel any discomfort during a session or after a previous session.

I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way.

I confirm that I have read and understood the above advice and that the information I have given is correct.

I confirm that my teacher may use the contents of this form, and any other information I may later provide, for teaching purposes, and that this information:

• will be used in confidence and stored securely

• will not, in any circumstances, be shared with a third party without my written consent, unless that party is another (Body Control) Pilates teacher who will teach me.

• may be retained by the teacher for a period of time such as complies with professional, legal and insurance requirements that they must fulfil

I DO/DO NOT (please delete) consent to any photos and videos taken of myself during class to be used on social media, for advertisement or any public platform. *

DO
DO NOT

I confirm agreement for my teacher to contact me with information on classes and other Pilates-related activities and understand that I have the right to withdraw this ‘consent to be contacted’ at any time. *

Enrolment Form

PERSONAL INFORMATION

YOUR HEALTH AND BACKGROUND

IMPORTANT INFORMATION

Move With Lu

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Classes

1-to-1

Contact

[email protected]