Name
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First Name
Last Name
Email
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Phone
*
(###)
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Gender
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Age
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What movement experiences/sports do you enjoy most? And how frequently are participating in them?
Please, write a little about your movement/sporting history.
Do you have any previous experience with Pilates/yoga/dance/gyrotonics?
Do you have any personal fitness/wellness goals?
Are you currently experiencing any physical limitations or difficulties? If so, please explain:
Are you currently undergoing any form of bodywork or receiving medical attention for the aforementioned injuries (i.e. Chiropractic, Medical, Massage Therapy, Physical Therapy)?
Please indicate if you suffer from any of the following ailments…
Is there anything else that you feel we should know about or have not asked? If so, please explain:
I the undersigned, do hereby certify that i have completed the above information and know it to be truthful and accurate to the best of my knowledge. Signature:____________________________________________ Date:___________________ Release and Waiver I understands that Pilates, Yoga, and Aerial fitness lessons at Studio 205 involve physical exertion, are strenuous, and that injuries may occur when participating. I voluntarily participate lessons at Studio 205 with full knowledge that there is a risk of personal injury. I accept and assumes the risks associated with Pilates, Yoga and Aerial lessons. I understand that it is my responsibility to consult with a physician prior to and regarding participation in Pilates or Yoga. Personal Property: I agree that Studio 205 is in no way responsible for the safekeeping of my personal belongings while I attend class. Cancellation/Refund Policy: 24-hour advance notice is required to change or cancel an appointment without charge. Appointments may be cancelled by phone, email or in person. All purchases are non-refundable. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions presented online at www.studio205.amsterdam. Client’s Signature: _________________________________ Date: __________________
