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Client Screening & Liability Release Form

Please complete the following:

Name *
Address *
Email *
Mobile *
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 *
Pregnancies – delivery? C-Section – how long ago? Specific issues postpartum: *
Do you have any areas which are affected by pain or injury? *
If 'Other' please specify *

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, property damage or wrongful death caused by negligence or otherwise.

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. For more details on how we manage your data, please read our Privacy Policy. *