• Intake Form

    Help us understand your body, goals, and preferences before your first session.
  • Please read the following small print details carefully before signing the contract. By signing, you agree to all terms and conditions outlined in this agreement, including cancellation policies, liability waivers, and confidentiality clauses.
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Appointment confirmations will be sent to the email you provide. You can use this same email to register your account at RealMcCoyPilates.com to monitor, book, cancel and purchase sessions. Would you also like to receive promotional and informational emails? These are usually sent seasonally. We try not to overdo it.*
  • Format: (000) 000-0000.
  • Check off days and times that would work for your schedule (check as many as apply):
  • Body Contour

    Please answer this section if you are interested in body contouring.
  • Are you sensitive to light or sun?
  • Do you have vascular or cardiovascular conditions?
  • Do you have any implanted metal or medical devices in your body?
  • Do you have a pacemaker?
  • Are you pregnant, nursing, or actively trying to become pregnant?
  • Do you have high or low blood pressure?
  • Do you have any liver or kidney conditions?
  • Do you have any thyroid or lymphatic conditions?
  • Have you ever been diagnosed with cancer?
  • Are you currently undergoing cancer treatment?
  • Do you have diabetes?
  • Studio Policies

    Please review and acknowledge the following policies and consent statements.
  • REAL MCCOY PILATES LLC, referred to herein as the “studio” and the undersigned client referred to herein as the “client”, hereby agree to the following terms and conditions regarding the client’s use of this studio.

    CANCELATION POLICY


    Scheduled sessions may be cancelled with 24 Hours or more without penalty. If notice of cancellation for a scheduled session is not received within 24 hours prior to a scheduled session, the session is forfeited. If you do need to cancel please give as much notice as possible so the slot can be available for another client. 

    ONLINE BOOKING

    Private, duet and small group classes can be booked online at www.realmccoypilates.com. Sessions, packages and subscriptions can also be purchased via the website. This helps you monitor you sessions available under your registered account. Sessions can also be cancelled online. 

    PHYSICAL CONDITION 

    The client represents, warrants, and agrees that the client is in good physical condition and that the client has no disability, impairment, or ailment that will prevent the client from engaging in active or passive exercise or that should be detrimental to the client’s health, safety, comfort, or physical condition should the client engage in active or passive exercise.

    The client acknowledges that the studio has neither made claims as to medical results nor suggested medical treatment to the client. The client acknowledges that the studio recommended that the client consult a physician prior to beginning this program. The client understands that it is the client’s responsibility to inform the studio of any pain experienced before, during or after participating in the exercise program so that the exercise may be immediately terminated. The client agrees that all known information of illness, pain, allergies, surgeries and other pertinent information have been shared with the studio for the safety and well-being of the client. Full communication and disclosure help with session planning, keeping everyone safe, injury free while maximizing progress and results. 

    REQUIRED CLOTHING

    Please wear appropriate athletic clothing that allows you to move freely. Clothing shouldn't be so loose that it's revealing or become a hazard with springs. 

    Please refrain from wearing clothing or belts with studs, zippers, buttons that can damage vinyl/mats. Please be mindful about perfumes, lotions and makeup. Classmates can be sensitive to strong scents; oils and lotions can damage equipment. Long hair should be tied up to avoid being caught. 

    Grip socks are required. Grip socks must be worn for safety and sanitary purposes. They can be purchased in the studio or online. 

    WAIVER 

    Client is familiar with and recognizes the danger and risk of injury to person and or property which may result from the use of studio’s facilities, including, without limitation, injury from slipping and falling, excess fatigue or stress, muscle strain, or any other unforeseen cause. With full knowledge and understanding of such risks, client agrees to use the facilities and the studio’s services rendered to the client at his or her own risk and PERSONALLY ASSUMES THE RISK for any harm, injury, or damage that may occur as a result from use of trainer’s facilities. Client hereby fully and forever RELEASES, RELINQUISHES, ACQUITS, AND DISCHARGES the studio and owner from any and all claims, demands, actions, causes of action and rights (whether known, unknown, contingent, accrued, inchoate, or otherwise) which client may have against Real McCoy Pilates or owner. Client expressly warrants and represents and does hereby state and represent that no promise or agreement which is not herein expressed has been made to him/her in executing this Release and Waiver of Liability, and that the client is not relying upon any statement or any representation of any of the Released Parties.


    I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

     

  • Date and Time of signature*
     - -
  • Media Release Authorization

    Please indicate your preferences regarding the use of photos taken during your sessions.
  • Photo Consent: Please select one option below.*
  • Date and Time of signature (Media Release)*
     - -
  • Should be Empty: