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Health & Safety Questionnaire for Pilates with Jacquie
Please complete and return ALL SECTIONS of this form before starting your first Pilates Class. Your details will not be passed onto any third parties.
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Email
*
Your email
Your Name
*
Your answer
Contact Telephone
*
Your answer
Address
Your answer
DOB
MM
/
DD
/
YYYY
Emergency Contact Name/Tel Number
*
Your answer
How did you hear about the classes?
*
Your answer
Name and Address of GP
*
Your answer
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