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10% off bundles of 10 mat classes €153.23 Inc 13.5% VAT
10% off bundles of 10 equipment classes €234.29 Inc 13.5% VAT
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Client Screening & Liability Release Form

Name:*
Address:*
Email:*
Emergency Contact:*
What are your specific health goals you wish to achieve by practicing Pilates?*
How would you describe your physical condition?*
Detail your physical history below:
Injuries:*
Ailments/Illness:*
Have you been diagnosed with any Musculoskeletal issues or Neurological conditions?*
Pregnancies – delivery? C-Section – how long ago? Specific issues postpartum:*
Please highlight any of the following areas which are affected by pain or injury:*
Do you have any Scoliosis, Spinal injury or degeneration conditions? If so, please elaborate:*
Other:
If you are injured, please follow your GP/Physiotherapists advice when practicing Pilates. Pilates is not a substitute for medical attention.
In initialling the below, I agree that Powerhouse Pilates is in no way responsible for the safekeeping of my personal belongings while I attend class. I agree to listen to my body and if experiencing any pain, ask for support and/or cease the exercise at once. I agree that I will take full responsibility for my safety and wellbeing whilst at Powerhouse Pilates studio and will not seek legal action against Powerhouse Pilates staff for personal injury or property damage.
Signed/Initials:*
Date:*
By selecting "I Agree" below, you consent to the processing of your personal data in accordance with our Privacy Policy. We will use your information solely for the purposes outlined in this form, and we will handle it with the utmost care and confidentiality. You have the right to withdraw your consent at any time.*