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Registration Form
Please fill in this class registration form prior to attending any classes so that each class can be tailored for you. Payment and booking for each class is required 12hrs prior to attending.
Pilates in the Park:
Casual Park Class $15
Private Personal Training/Massage $75-150 (1 person)
Casual studio class $45pp (2ppl)
Bank Transfer to:
Marnie C Wolff
064804-12866551
NB. Please indicate your name in the bank description.
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Email
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Your email
Name
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Your answer
Do you have a Messenger Name (Facebook) for quick confirmations?
Your answer
Are you interested in regular sessions? If so, what days/times are your preference?
Your answer
Telephone Number
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Your answer
What is your current exercise routine?
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Your answer
Do you have any health or medical problems? E.g Heart Issues, asthma, high or low blood pressure, dizziness, chest pains, arthritis, osteoporosis, epilepsy, diabetes, etc, that we should know about? *
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Detail
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Do you have any pain of injuries/conditions (new or old) that may affect your movements in any way? *
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NO
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Do you have any pain of injuries/conditions (new or old) that may affect your movements in any way? *
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YES
NO
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Do you take any medication that I should know about? *
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Have you been referred by a health practitioner/medical professionals?
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Please provide any further information that I should know about that may affect your performance in my class?
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What do you hope to achieve with the help of Your Space Pilates? What are your goals?*
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All the information given is true and correct and I have provided Marnie Wolff at Your Space Pilates with all the information about my health and wellness that may restrict my ability to perform a class. I have read and understood all wording and acknowledge it is my responsibility to inform Marnie Wolff at Your Space Pilates of any changes to the information given. I understand that Marnie Wolff at Your Space Pilates is completely absolved and unreservedly from any liability or legal proceedings resulting from acts of active passive negligence. I at all times reserve the right to stop at any time and am under no obligation to complete any programme that I do not feel is appropriate for me. *
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I agree that my body is my responsibility and I will let my instructor, Marnie Wolff know if I experience any pain or discomfort during the class. *
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I acknowledge that if my instructor, Marnie Wolff feels that I am unfit to participate in the workout, she will request that I discontinue the workout. *
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I am aware of the Your Space Pilates cancellation policy and agree to the terms and conditions of the use and access of their facilities. SEE POLICY BELOW.*
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Cancellation policy: If you need to change or cancel your scheduled appointment, email (
marnie@yourspacepilates.com.au
) or call Marnie (0412621569) within 24 hours notice.
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Marnie Wolff at Your Space Pilates requests your permission to use any photographic image of you for advertising purposes only. Do you give your consent?
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A copy of your responses will be emailed to the address you provided.
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