Pilates informed consent form
(Pilates with Veronika)
Name
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First Name
Last Name
Date of birth
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-
Month
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Day
Year
Date
Phone Number
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+44
Phone Number
Email
example@example.com
Do you have any injuries?
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Yes
No
Do you have any physical disabilities?
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Yes
No
Do you have any cardiovascular disease?
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Yes
No
Do you have any asthma?
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Yes
No
Do you undergo any recent surgery?
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Yes
No
Are you currently pregnant or have you given birth in the last 12 months?
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Yes
No
Do you have any medical condition or injuries that you would like to share? Do you have any movements that you are not allowed to do or cause pain? Anything that I should be aware of? If you answered Yes to any questions, please explain it. Please take note that this information is strictly confidential.
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CONSENT AGREEMENT I, the undersigned, hereby acknowledge and understand that participation in Pilates classes conducted by Veronika Molnar involves certain risks and potential dangers. I commit to follow instructions provided by the instructor. By signing this waiver, I voluntarily agree to participate in the class and assume all risks associated with my participation. Assumption of Risk:I acknowledge that I am voluntarily participating in the Pilates class(es) provided by the Provider. I understand that physical exercise, by its very nature, carries with it certain inherent risks, including but not limited to physical injury, strain, discomfort, and even the possibility of serious injury. I hereby assume all risks and responsibility for any such injuries or other medical incidents. Waiver and Release:I hereby release, waive, discharge, and agree not to sue the Provider from any claims, demands, liabilities, rights, damages, expenses, and causes of action of any nature arising out of or in connection with my participation in the Pilates class(es), whether caused by the negligence of the Provider or otherwise. Medical Representation:I represent that I am physically fit to participate in the fitness class(es) and have no medical condition that would prevent my safe participation. If I have any medical conditions or concerns, I have consulted with a healthcare provider and obtained clearance to participate.Consent to Medical Treatment:I hereby consent to receive any necessary medical treatment resulting from my participation in the Pilates class(es) and agree to bear all costs associated with such Acknowledgment:I have read this Fitness Class Waiver, understand its contents, and agree to be bound by its terms. I understand that I am giving up substantial legal rights by sibmitting this document.
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AGREE
Date
*
-
Month
-
Day
Year
Date
Submit
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