Pregnancy Mat Pilates - Small Group Booking
(Pilates with Veronika)
MONDAYS 6PM-7PM @GREEN PARK COMMUNITY CENTRE, NEWPORT PAGNELL, MK16 (Please bring your mat. All other equipments will be provided.)
Booking options (Please choose the date/dates below. Free cancellation/rescheduling by 12pm the day before the session.)
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Single Session (£13.50)
4-Week Block (£44)
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Name
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First Name
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Email
example@example.com
How many weeks pregnant are you?
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Due date:
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Is this your first pregnancy? (If not, were there any complications in previous births?)
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Have you been cleared by your Midwife/GP for exercise?
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Yes
No
Are you experiencing any of the following? (Pelvic Girdle Pain (PGP)/SPD, Lower back pain, High/Low blood pressure, Gestational Diabetes, Dizziness or Faintness) If so, please give me more details.
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Are there any other medical conditions or injuries I should be aware of? If so, please give me more details.
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1. Physical Readiness: I confirm that I am currently experiencing a low-risk pregnancy and have received clearance from my GP or Midwife to participate in Prenatal Pilates. I agree to inform Veronika immediately of any changes to my pregnancy, such as high blood pressure, dizziness, or new medical diagnoses.2. Specialist Nature of the Class: I understand that this class is a Specialist Small Group (maximum 8–10 participants) designed specifically for pregnancy. I acknowledge that while the exercises are tailored for safety, it is my responsibility to monitor my own body. If I feel any pain, shortness of breath, or discomfort, I will stop the exercise immediately and inform the instructor.3. Assumption of Risk: I understand that any physical activity carries a small risk of injury. I voluntarily assume all risks associated with my participation in this class and agree that Veronika Molnar (Pilates with Veronika) shall not be held liable for any injuries or complications, provided the instruction was given with reasonable care and within the scope of a qualified Prenatal Specialist.4. Booking & Cancellation PolicyPayment: My space is only secured once payment (£44 for the block or £13.50 for a single session) is received via bank transfer.Cancellations: I understand that to reschedule or cancel a session, I must notify Veronika by 12:00 PM (midday) the day before the class. Failure to do so will result in the loss of that session fee.Make-up Sessions: Subject to availability, I may attend a regular Pilates session within the same week if I cannot attend the Monday Prenatal class.5. Informed Consent: I have read this form in its entirety and understand its contents. I am signing this freely and voluntarily.
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AGREE
Thank you for completing this form. I will contact you shortly with the payment details. Please note, you don't need to fill in this form again for future bookings. Bookings could be done via our private WhatsApp group or personally.
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