Registration Form

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Tel: 07830 085606
sharonpilates@hotmail.com

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Home
Pilates
Bookings & Timetable
Online Pilates Studio
About
Contact
- Contact
- Cookies & Privacy Policy

Menu

Tel: 07830 085606
sharonpilates@hotmail.com

Please fill in the following registration form:

Name *

First

Last
Email Address *
Address *
Telephone *
Date of Birth *
Emergency contact name and phone number: *
Class day and time you’d like to join: *
Please answer the following questions. If you answer yes to any, please give as much detail as you can at the end of the form.
How is your general health? *
Are you currently experiencing back, neck or shoulder pain? *
Yes No If yes, please enter details at the end of the form
Have you ever had an episode of back, neck or shoulder pain? *
Yes No If yes, please enter details at the end of the form
Are you currently experiencing high or low blood pressure? *
Yes No If yes, please enter details at the end of the form
Have you had any recent surgeries, injuries or illnesses? *
Yes No If yes, please enter details at the end of the form
Do you take any medication? *
Yes No If yes, please enter details at the end of the form
Are you liable to faint or have dizzy spells? *
Yes No If yes, please enter details at the end of the form
If applicable, are you pregnant or have you had a baby in the last year? *
Yes No If yes, please enter details at the end of the form
Have you ever done Pilates? *
Yes No If yes, please enter details at the end of the form
What is your general fitness level? *
Yes No If yes, please enter details at the end of the form
Do you take part in any sport? *
Yes No If yes, please enter details at the end of the form
Circle any of the following conditions that you have been diagnosed with or treated for: *
asthma arthritis stroke diabetes cancer osteoporosis heart disease depression bronchitis dermatitis epilepsy None Please select any which apply or select none.
Are there any other health related matters that may have an impact on your ability to exercise? *
What are your aims for beginning pilates? *
What is your occupation?
Have you answered yes to any of the questions? If so please give as much detail as possible below:
Comments or further details *
Your Confirmation:
I have not been advised to avoid exercise and/or Pilates by a doctor or other health professional. I confirm that I have read, understood and answered to the best of my ability this questionnaire. *
I Agree
Date *
GDPR Explicit Consent Data Protection Agreement
I explicitly consent to you creating and storing health & exercise records concerning my attending your Pilates classes. I understand that these records will be processed in accordance with your Privacy Policy, a copy of which I can request to see. *
I Agree
Date *

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GDPR Explicit Consent Data Protection Agreement