Pilates Booking Form

1
WEDNESDAY, 9.30am -10.30am. Portfields Community Centre (Please select the date or skip this question.)
Date
Year
Month
Day
2
TUESDAY, 6pm -7pm. Portfields Community Centre (Please select the date or skip this question.)
Date
Year
Month
Day
3
WEDNESDAY, 6.15pm -7.15pm. Green Park Community Centre (Please select the date or skip this question.)
Date
Day
Month
Year
4
THURSDAY, 11am -12pm. Newport Pagnell Youth Club(Please select the date or skip this question.)
Date
Year
Month
Day
5
THURSDAY 6.30pm -7.30pm. NewportPagnell Youth Club (Please select the date or skip this question.)
Date
Year
Month
Day
6
THURSDAY 7.30pm -8.30pm. NewportPagnell Youth Club (Please select the date or skip this question.)
Date
Year
Month
Day
7
FRIDAY 9.30am -10.30am. NewportPagnell Youth Club (Please select the date or skip this question.)
Date
Year
Month
Day
8
Full Name* This field is required.
First Name
Last Name
9
Your Phone Number* This field is required.
Area Code
Phone Number
10
Do you agree to pay £9 per a 1 hour session? (Payment has to be made in advance. I will send you the payment details. For block booking -minimum of 4 sessions- you will receive 25% discount, so you pay £8 for 4 classes.)* This field is required.The session must be paid in advance. Free cancellation is by 12pm a day before the class. You will receive the booking and cancellation policy and the Informed Consent form shortly after submitting your form. If you would like block booking for Loyalty discount (£8 pp), I will sort out the dates with you.
YESNO
11
Do you have any medical conditions/disabilties/injuries I should be aware of?* This field is required.
YESNO
12
If so, state your medical conditions/disabilities/injuries:
Huge
Large
Normal
Small
Ok
Ok
13
Have you done Pilates before?* This field is required.
Yes, I am experienced
Yes, but I am a beginner
Never done Pilates before
14
Are you able to bring your own mat?* This field is required.
YESNO
Should be Empty: