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Name:
Email:
Have you done Pilates before?
Yes
No
Do you have high or low blood pressure or heart disease?
Yes
No
If yes, please elaborate:
Are you pregnant?
Yes
No
If you are pregnant, beginning a Pilates program may not be the best choice for you. Please call our front desk to set up a phone consultation with one of our instructors.
Are you taking any medication that may affect you during exercise?
Yes
No
If yes, please list:
Do you have any current or acute pain or injuries?
Yes
No
If yes, please elaborate:
Please list any major injuries, illnesses or surgeries in your life time:
Waiver of Liability
I understand that participation in Pilates and any other conditioning
activity presents some unavoidable risk of injury, especially to people who have pre-existing injuries, illnesses
or medical disabilities.
I understand that the use of exercise equipment also carries with it risk of injury.
I understand a medical evaluation is advisable before commencing any program of physical conditioning or exercise. I intend to keep Vitality Pilates personnel fully informed
of any physical condition or disability which would prevent or limit my participation in an exercise or physical
conditioning program.
I acknowledge that neither Vitality Fitness Incorporated nor its employees
are engaged in diagnosing or treating medical diseases or deficiencies.
I expressly assume all risks of my participation in the programs of
Pilates conducted by Vitality Fitness Inc. and waive any claim which I might otherwise bring against Vitality Fitness
Inc. and its personnel as a result of injuries resulting from or relating to my participation in Pilates
programs.
Vitality Fitness Inc. is not responsible or liable for any articles
lost, stolen or damaged, in or about the studio premises.
I understand that all purchases are non-refundable.
Please acknowledge that you have read through this contract/agreement/waiver.
I agree to the terms above.
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