FREE Stott Pilates Mat Try Out Class January 2025

Falconè Pilates. Register for your FREE Stott Pilates Mat try out class! Coming January 2025 at Willingdon Memorial Hall (See your FREE CLASS ticket for full address) Date to be confirmed soon!

REMEMBER: Bring your Free ticket to gain entry to the class. Bring your own mat, water & a small towel
Please enter your FREE CLASS Code. You will find your code in the bottom right hand corner of your Free Ticket.*
Today's date*

DayMonthYear
I am aged 18 or over*

Yes
Name*

First NameLast Name
Email*

Confirmation EmailPlease confirm your email address
Phone Number*
Please enter a valid phone number.
Date of birth*

MonthDayYear
What do you hope to get out of your FREE Pilates class?*
Would you like to hear about our future events?*

YESNO
HEALTH QUESTIONNAIRE
If you answer YES to any of the questions below or you are not used to being very active you should first check with your doctor before taking part this or in any exercise programme.

Common sense is your best guide. Please read the questions below carefully and answer each one honestly by selecting YES or NO.

We do not share your data with any third party.
1. Do you have a heart condition, have ever had a heart attack or a stroke?*

YESNO
2. Do you feel pain in your chest when taking part in physical activity?*

YESNO
3. Do you have blood pressure issues?*

YESNO
4. Do you sometimes feel dizzy or lightheaded during exercise?*

YESNO
5. Do you get breathless or have breathing problems?*

YESNO
6. Are you pregnant?*

YESNO
6. Do you smoke?*

YESNO
7. Do you know of any other reason why you should not partake in physical activity such as Pilates?*

YESNO
YOUR SIGNATURE*

Clear
If you answered yes to the above question, please leave your comments here.
8. What is your current level of Pilates experience?*

BeginnerSome experienceIntermediateAdvanced
If you answer YES to any of the questions above, or if you are not used to being very active, you should first check with your doctor before taking part in this Free Pilates class.

By signing this form you agree the information you have given here is true and correct to the best of your knowledge.

This form and the information you have given is valid until you have completed your free class in January 2025.

IMPORTANT: If there is any change to your physical health from the time of completing this form to the day of your class. It is the your responsibility to notify us at Falconè Pilates of any physical changes prior to the class taking place.

I understand that any form of physical activity can bring risks of injury and understand that I participate at my own risk and I will not hold Falconè Pilates responsible for any damages or injuries.

By signing this form you agree with all of the above.
Which of the following services are of most interest to you?*

Private CoachingGroup Classes Face-FaceOnline Group ClassesFollow along YouTube free workoutsNews Letters I.E. For Health Tips
Please verify that you are human*
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Falconè Pilates. Register for your FREE Stott Pilates Mat try out class! Coming January 2025 at Willingdon Memorial Hall (See your FREE CLASS ticket for full address) Date to be confirmed soon!

HEALTH QUESTIONNAIRE