Soul Movement – Online Studio Waiver & Induction Form

Personal Information
Full Name
Date of Birth

DayMonthYear
Date
Gender
Address
City
Phone Number
Email Address
Emergency Contact
Full Name
Relationship to You
Phone Number
Medical Provider
Safety Induction Checklist
I confirm I have:
Health Information
Medical Conditions (tick any / all that apply):
Cardiovascular & Pulmonary
If ticked, you must only proceed with medical clearance
Risk Factors
Musculoskeletal Concerns
Pelvic Health
Have you given birth? If yes, how many times
Please explain any ticked items, surgeries, medications, or physical limitations:
Fire & Ice (Contrast Therapy) – If applicable
Contraindications – Please tick if any apply:
If any apply, consult a medical professional before proceeding.
I acknowledge I’ve been instructed on safe entry/exit, time limits, and temperature exposure for the sauna and ice bath.
I agree to stay hydrated and listen to my body throughout the session.
Studio participation
Please confirm:
Pilates Experience:
What are your movement goals?
Informed Consent & Waiver
I confirm
Full Name
Signature
Todays Date

DayMonthYear
Date
Should be Empty:

Personal Information