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Injury Information

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You have indicated that you do, or might have an injury or illness that may restrict your ability to do a Studio Pilates class. Please outline the relevant information below and provide as much detail as you can.

Your information will be securely kept in the strictest confidence and shared only with the instructors that are required to know this information to be able to help you.

Name(Required)
Do you have any health or medical problems? Eg; Heart Issues, asthma, high blood pressure(Required)
Do you have any pain or injuries/conditions that may effect your movements in any way?(Required)
Are you currently pregnant or have you recently given birth in the last 6 months?(Required)
Have you had any recent surgeries that we should know about?(Required)

Waiver of Liability and Prospective Release Form for Studio Pilates International

I declare that I am over 18 years of age (or have otherwise provided parental consent) and acknowledge and understand that I have voluntarily chosen to participate in the classes and activities offered by Studio Pilates International.

I acknowledge and agree that the workouts are a recreational sports activity and may involve strenuous physical activity including, but not limited to stretches, lifts, use of props, use of reformer machines, gymnastic movements, strenuous bodyweight exercises and other strenuous activities that I am not obliged to perform, nor am I obliged to participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during classes.

I understand that there are inherent risks in all aspects of physical exercise, and I acknowledge that I have been informed of the possible strenuous nature of training. I agree that prior to my participation I will inform Studio Pilates International of any known medical conditions or factors that may place me at risk. Studio Pilates International may request a medical release from my medical practitioner prior to participation. I will inform Studio Pilates International of any symptoms before, during and after participation in a Studio Pilates International class.

I also understand that if I am a prenatal or postnatal client, that I must consult with my physician and receive clearance to perform physical exercise.

I release Studio Pilates International and its staff, employers and agents from any and all liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the classes, activities and services provided by Studio Pilates International.

I agree to hold harmless and indemnify Studio Pilates International and its employees and agents from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in any program, activity or service provided by Studio Pilates International. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full force and effect.

In checking the box below I declare that I have advised Studio Pilates of any injury, back, neck or joint pain, restricted movement, heart issues, asthma, or high or low blood pressure, arthritis, slipped or bulging vertebral disk, pelvic floor conditions, dizziness, diabetes, epilepsy, hernia, bone degeneration, high cholesterol, allergies or chronic illness. I also declare that I have notified Studio Pilates if I am pregnant and/or have given birth in the last 12 months, or if I have undergone surgery in the past 12 months.

If any of the above health conditions apply to you, please include full details in this form.

Studio Pilates International shall not undertake any obligation (whether contractually, at common law or otherwise) to advise or treat me in relation to any of the matters referred to in the preceding paragraph. I acknowledge that it is my obligation and mine alone to take responsibility for my health and wellbeing during any type of exercise I undertake with Studio Pilates International.

By checking this box below, I acknowledge that Studio Pilates International shall not be liable or responsible to me for articles lost, damaged or stolen from any of its studios.

By checking the box below I also acknowledge that I am aware that to ensure that Studio Pilates International is able to provide me with the best possible service, all studios have been fitted with CCTV cameras and audio that are operated on an ongoing basis. These cameras and audio are used strictly for security, protection and training purposes only. Access to this footage is restricted and can only be viewed by authorised personnel.

I understand that from time to time Studio Pilates International and/or its employees or contractors may film or photograph the classes, activities or services provided by Studio Pilates International. By checking the box below, I permit Studio Pilates International and its licensees or assignees to use, publish, reproduce, distribute, create derivative works of, perform, display and/or otherwise exploit my name, image, voice and likeness, either complete or in part, alone or in conjunction with any wording, for uses including publicity and/or merchandising and/or editorial purposes in any country in connection with any part of the business of Studio Pilates International in any manner and in all forms of media whether now existing or developed in the future. I hereby waive any right to inspect and approve the photographs or videos or the printed/digital/electronic matter that may be used in conjunction with them now or in the future, regardless of whether that use is known or unknown. I waive any right to copyright or royalties or other compensation from or related to use of the photography or videos or adaptations thereof.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

I acknowledge that this waiver may be pleaded in response as a bar to any legal proceeding taken by me or on my behalf.

Please note: terms and conditions of this release form and waiver of liability are subject to change without notice.

All persons under 18 years of age must have this form signed on their behalf by a parent or guardian before attending a Studio Pilates International class. Once the parent or guardian has signed the waiver, persons under 18 years of age may attend Studio Pilates International classes.

I certify that I have read and understand this waiver, have provided it voluntarily, and intend it to be enforceable to the maximum extent permitted by law. I agree that if any part of this waiver is declared invalid, the rest of this waiver will continue in full force and effect.(Required)
All the information given is true and correct and I have provided Studio Pilates with all the information about my health and wellness that may restrict my ability to perform a class(Required)
I agree that my body is my responsibility and I will let my instructor know if I experience any pain or discomfort during the class(Required)
I acknowledge that if the instructor feels that I am unfit to participate in the workout, they will request I discontinue the workout(Required)
* Required Fields
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