New Client Form
New to Holly Louise Pilates? Please fill in the form prior to your class. This is mandatory.
Name
*
First Name
Last Name
Email.
*
example@example.com
Date of birth
*
-
Day
-
Month
Year
Date
Phone Number
*
Format: 00000000000.
Emergency Contact Details
*
Full Name
Contact Number
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Are you pregnant or have you given birth in the last 12 weeks?
*
Yes, I am pregnant
Yes, I have given birth in the last 12 weeks
No
If you selected 'Yes, I am pregnant', please state the week number
How did you hear about us?
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Google
Word of Mouth
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Please inform me before starting any class if, for any reason, your health or ability to exercise changes. Please inform me immediately if you feel any discomfort during a session. If you have any concern please do check with your GP. Holly Louise Pilates cannot accept any liability for personal injury related to participation in a Pilates session if: • your doctor has advised you against such exercise. • your medical situation changes and you fail to inform the teacher and the studio. • you fail to observe instructions on safety or technique. • you are injured by the negligence of another participant in the class/studio. I understand that Pilates exercises can involve hands-on correction and feedback and I hereby consent for my instructor to work in this way. I understand that I will be charged if I cancel my booking within 24 hours or do not attend. I confirm that I have read and understood the above advice and that the information I have given on this form is complete and correct.
*
Yes, I agree to the terms & conditions.
Date
*
-
Day
-
Month
Year
Date
Do you have any current injuries or injury history? If yes, please do provide details.
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