Pilates by the Green – Enrolment Form

Pilates by the Green

Enrolment Form

Please fill out the form below to enrol in our Pilates studio. All information will be treated in the strictest confidence.

Personal Details
Emergency Contact Details
Your Background

1. Does your work/sport involve any of the following? (please tick)

2. Will this be the first time that you have practiced Pilates? (please tick)

If NO, have you previously attended(please tick)

Number of classes attended:

Your Health

3. Has your doctor ever said that you have any sort of heart trouble or defect?

4. Do you feel pain in your chest when you do physical activity?

5. Are you, or could you, be pregnant now?

6. Have you been pregnant in the last six months?

7. Do you often get headaches?

8. Do you lose your balance because of dizziness, ever lose consciousness, feel faint or dizzy?

9. Is your blood pressure:

10. Have you had major surgery in the last 10 years?

11. Have you had minor surgery in the last 2 years?

12. Do you suffer from asthma, diabetes or epilepsy?

13. Have you ever been told that you have arthritic joints or any bone or joint problems that may be made worse by exercise?

14. Do you suffer from osteoporosis?

15. Do you suffer from back or neck pain?

16. Do you have pain or restricted movement in any other joints (e.g. hip, knee, ankle, elbow, shoulder)?

17. Have you been diagnosed as hypermobile (excessive joint mobility)?

18. Are there any movements that cause you pain?

19. Are you taking any drugs or medication which may affect your ability to exercise?

20. Have you been referred to Pilates by a specialist practitioner?

If you have answered YES to any of the questions above we advise that you consult with your medical practitioner before you start Pilates classes.

Your Aims
Important Information & Declarations

Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes that may be made worse by exercise.

Pilates exercises are very safe but, as with all forms of physical exercise, it is prudent to consult your doctor before starting Pilates sessions. These sessions are not a substitute for medical counselling or treatment.

If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner.

The teacher can accept no liability for personal injury related to participation in a session if:

  • your doctor has, on health grounds, advised you against such exercise.
  • you fail to observe instructions on safety or technique.
  • such injury is caused by the negligence of another participant in the class/studio.

Exercise should be performed at a pace which feels comfortable for you. Pain is the body’s warning system and should NOT BE IGNORED. Please inform your teacher immediately if you feel any discomfort during a session.

It is inadvisable to do Pilates between weeks 8 to 14 of pregnancy, unless by special arrangement with your teacher. It is also wise to wait six weeks after the birth before resuming exercise.

All sessions payable in advance.

24 hours notice required for cancellation otherwise the full session rate will be charged.

Advance payments are non refundable and non transferrable.