Pilates Client Waiver

First name

Last name

Phone

Birthday

Day

Month

Year

Are you taking medication which may effect you during the session?

Do you have any illness or Disabilities?

Do you have any injury or joint problems?

Have you had surgery in the past 12 months?

Have you been pregnant in the past 6 months?

Have you ever done Pilates before?

Are you aware of any reason that you should not participate in physical activity without medical supervision? If yes, please provide details:

Any music requests? (favourite artist or genre)

By signing below, I acknowledge and agree that:

I have voluntarily chosen to participate in the Pilates 1:1 service provided by Sally Heinjus.

I have read, understood, and agree to the Terms and Conditions (https://www.sallyheinjus.com/pilatestermsandconditions)

I release and discharge Sally Heinjus from any liability, claims, demands, or causes of action arising from my participation, except where prohibited by law.

I confirm that all information provided on this form is true and complete to the best of my knowledge.

I understand that it is my responsibility to inform the instructor if I experience any new or unusual symptoms during the course of my sessions/classes.

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