BAREFOOT4LIFE 
Registration form
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Email *
Which service are you interested in?
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Do you know the class date you want to book in for? *
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First name and surname 

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What is your Date of birth *
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Address *
Mobile number *
Emergency contact details (name and mobile number) *
Have you done Pilates before? *
How often do you exercise and what kind of exercise do you do? *
Any pre-existing conditions, past injuries and/or surgeries? *
Medical history - do you have or have you had any of the following? 

As with any exercise program your safety is the main priority. Please complete the below list of medical history and ask your GP to give you the all clear if any of these conditions apply. The instructor may ask you to obtain medical clearance for Pilates if they have any concerns about your safety during classes or sessions. 

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Any other additional info that the instructor should know about? *

I voluntarily desire to participate in physical and rehabilitation and/or exercise training classes in person, including Online live video conferencing, pre recorded downloads on Youtube or the such like conducted by Caroline Fick from Barefoot4life and understand and agree to the following:

1.  I am aware that there exists the possibility of certain conditions occurring during or following training and/or exercise.  These include, but are not limited to: mild light headedness, fainting, abnormalities of blood pressure or heart rate, ineffective heart function and in rare instances, heart attack or stroke.  The reaction of the cardiovascular system to such activity cannot be predicated with complete accuracy.

2.  It is strongly recommended that I receive a medical clearance from my GP prior to starting an exercise-training program.  This program is not designed for persons with known heart disease with or without functional impairment.

3.  I expressly agree that I have been informed that the program involves possible risks and all exercises shall be undertaken at my sole risk and that Barefoot4life (Caroline Fick) shall not be liable to me nor any other person, for any claims, demands, injuries, damages, actions or causes of action, whatsoever, to my person or property arising out of or connected to my services, facilities, and exercise classes or the Facility where the same is located (BS3 Community Development or Wrington Chapel).  I do hereby release and discharge Barefoot4life and the Facility thereof from all claim, demands, injuries, damages, action, or causes of actions and from all acts of active or passive negligence on the part of Barefoot4life (Caroline Fick).

4.   As with all fitness and exercise programmes, when using this exercise video you need to use your common sense. To reduce and avoid injury, you will want to check with your doctor before beginning any fitness programme. By performing any fitness exercises without supervision, you are performing them at your own risk. Barefoot4life (Caroline Fick) will not be responsible or liable for any injury or harm you sustain as a result of this fitness programme, DVD, online fitness video or information shared on our website. This includes emails, videos and text.

5.   I,  the undersigned, do hereby certify that I have completed the above information and know it to be truthful and accurate to the best of my knowledge.  I have read the above statement and understand the above conditions.  I am aware that if I am unable to attend a class, that classes are non transferrable, nor refundable.

6. I, understand that my data will not be transferred to any 3rd parties but agree that my email address can be used by the instructor to update me with class information and occasional class promotions.

 

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Signed *
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