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?
Please Select
Google
Word of Mouth
Instagram
Facebook
TikTok
Other
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.
FOR 1-2-1 REFORMER ONLY: Have you ever done reformer Pilates before?
Yes
No
If yes, what level have you been working at?
Please Select
Beginner
Intermediate
Advanced
Submit
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