Client Enrolment Form

This form is designed to help us gather more information about you. It is completely confidential and is not used as a diagnostic tool. Please answer the questions as completely as possible.


Personal Details



Emergency Contact Details


Please give details of two people whom we may contact in case of emergency


PART 1: Your Background and Your Health


If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below
If YES, please provide details in the Other Details box below

Please list in the box below any health problems you suffer, not already mentioned, that may affect your ability to exercise. If you have answered YES to any of questions 3-16 above, we advise that you consult with your medical practioner before you start Pilates classes. Please give further relevant details below, in confidence, to any questions marked YES.

Are there any factors that your teacher should be aware of that may prevent you from regularly attending classes (such as child care, lack of transport, shift work)?


PART 2: Your Aims



PART 3: Other Information



PART 4: Important Information - Please Read


Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes.

Pilates exercises are very safe, but as with all forms of physical exercise, it is prudent to consult your Doctor before starting Pilates sessions.

These exercises are no substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner. The teacher can accept no liability for personal injury related to participation in a session if:

- Your doctor has not given you medical clearance to exercise/to continue to exercise
- You fail to observe instructions on safety and technique
- Such injury is caused by the negligence of another participant in the class

The exercises, and the transitions between exercises, should be performed at a pace which feels comfortable for you. PAIN is the body's warning system and should not be ignored. Please inform your teacher immediately if you feel any discomfort, dizziness, nausea or pain during the session. Please also inform the teacher if you felt any discomfort after a previous session.


By clicking on the 'Submit' button below, you confirm that you:

- understand that Pilates involves hands-on correction and you give consent for your teachers to work in this way.
- accept that you remain ultimately responsible for your own health and safety.
- have read and understood the advice above and the information you have given in this form is correct and applicable to you.

Please click the submit button once and wait for confirmation message