Application Form

Application Form

Below is the application form to complete in order to be considered for gaining free access to one of our Pregnancy or Post Natal Pilates courses as part of our feedback and development process. By participating in our trial, you will be helping us to ensure that our course content meets the needs of our customers so thank you!
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Age*
If applicable, please tell us how many children you already have and their ages*

Which Course are you interested in testing?*
Please describe your pre-pregnancy level of activity and exercise (and during pregnancy if applying for a Post Natal recovery course).*
Why are you interested in taking part in this trial and what do you hope/expect to gain?*

For Pregnant Applicants Only

Please skip to the next page if not pregnant
What is your expected due date?

MonthDayYear
Date
Is your pregnancy...

SingleMultipleUnknown
Did you undergo fertility treatment to conceive the baby you are currently carrying?

YesNo
I understand this is a difficult question, but please let us know if you have experienced one or more miscarriages including the date and stage of pregnancy as taking care of you and your baby is my top priority.
Please let me know of any health conditions (pregnancy related or not), recent surgeries or medication you take.

For Post Natal Applicants Only

Please skip to the next page if you have not given birth yet
When did you give birth to your most recent baby?

MonthDayYear
Date
At which week of your pregnancy was your baby born?
Which of the following are applicable to your delivery?

Vaginal Birth (unassisted)Vaginal Birth (assisted)Planned C-SectionUnplanned or Emergency C-Section
Please let me know of any health conditions (pregnancy or birth related as well as separate), recent surgeries or medication you take.

For Pregnant Applicants Only