Experiences and Retreats Health Waiver

Pilates Spa Experience Guest Registration and Form

First name

Last name

Date of birth

Day

Month

Year

Emergency contact

How would you rate your Pilates ability ? Beginner, Intermediate or Advance

Do you have any current injuries or Physical Limitations ?

Do you have any respiratory conditions eg asthma ?

Do you have any musculoskeletal conditions ? Back Pain , Joint problems

Do you have and cardiovascular conditions eg heart condition , high blood pressure ?

Are you pregnant or have recently given birth ?

Have you had any surgery in the past 12 months ?

Do you have any other health concerns I should be aware of

Dietary requirements, Vegan, Vegetarian, Gluten free etc. No dietary restrictions happy to eat anything . Lunch will be served buffet style

You consent to minimal photography during your session — primarily discreet back and side images that won't disturb your practice. No photography will take place in the spa, for the privacy of all guests. Images may be used for marketing purposes

Spa is used at your own personal discretion

Will you need a mat too practice on the day ?

Liability Waiver. I confirm the information on this form is accurate . I understand that pilates and spa activities involve physical movement and I voluntary choose to participate. I agree to tell the instructor of any changes before the event

I hereby give my consent and agree to the terms and conditions outlined in this form

Date

Day

Month

Year

Yes, subscribe me to your mailing list - no spam

Signature

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