• Pilates Class - Initial Registration

  • INFORMED CONSENT FOR EXERCISE PARTICIPATION


    I desire to engage voluntarily in a Pilates exercise program given by Clark Integrated Medical Clinics. I understand that the activities may be strenuous, and may require me to do body movement that I am not familiar with in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workouts. Should any unusual symptoms occur, I will cease my participation.


    In signing this consent form, I affirm that I have read, accept and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with Pilates’ fitness classes and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety.

    I take full responsibility for my own health and safety in participating in the Pilates fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities.

     

    AGREEMENT AND WAIVER / RELEASE OF LIABILITY


    In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns to:
    1. Waive, release and discharge from any and all liability to Alynn Dugas, J. Scott Clark, Clark Integrated Medical Clinics, and any appointed instructor, or other students for my death, disability, personal injury, property damage, or property theft, or actions of any kind which may hereafter accrue to me in activities related to my training.
    2. Indemnify and hold harmless Clark Integrated Medical Clinics, and any of their instructors and students, from any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation in this activity. Therefore, intending to be bound and as a condition of being allowed to participate in the fitness class, have freely signed this waiver on the date indicated.

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  • Photo/Video Waiver

    I give Clark Integrated Medical Clinics and any partners permission to post and tag (with my full name) photos and videos containing my image on their website, Facebook, Instagram, Twitter, YouTube, other social media and in print and video for promotional and marketing purposes.

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  • READINESS FOR TRAINING

    Please complete to the best of your ability.
  • Current Nutrition & Hydration

    Adequate nutrition and hydration is critical to maintaining energy level during your workout and avoiding fatigue, light-headedness and fainting. Likewise, overeating prior to a workout can cause upset stomach and vomiting with intense exercise.

     

    I commit to notify my trainer if I am unsure about whether I have eaten enough prior to working out or if I have eaten a large meal in the past 2 hours.

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  • By participating in this class I commit to ask for instruction on any exercise I am not familiar with. I acknowledge that this is important to avoid injury. (You can’t make progress if you’re hurt!) I commit to notify my instructor if I do not know how to do something.

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  • I commit to work at a pace that is safe for me and within my current limits and notifying my trainer if I feel unwell.

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  • PAYMENT

    Once registration is submitted, you will receive an email for payment.
  • CLASS SIZE IS LIMITED TO 6 PARTICIPANTS.

     

    SINGLE CLASS $30
    PRIVATE SESSION $80
    10 CLASSES $250
    20 CLASSES $500
    12 MONTHS UNLIMITED CLASSES $3680

    *INTRODUCTORY SPECIAL

    10% off of every class scheduled for the first month.

     

    PLEASE NOTE: Clark Integrated Medical Clinics operates on a scheduled hourly appointment bases. Therefore, when cancelling an appointment for pilates, you are required to provide move than a 24 hour notice, for which no additional levy shall be incurred. However, if a participant is to cancel a session LESS than 24 hours to the scheduled time or no-show a class, they shall be charged the cancellation fee of $15.

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