MEDICAL INFORMATION + Ts & Cs AGREEMENT Name First Name Last Name Phone (###) ### #### Email Emergency Contact Phone (###) ### #### Are you CURRENTLY suffering from any of the following: Asthma Diabetes Hypertension Cardiac Disease Cancer Spinal Concerns Musculoskeletal Discomfort Injury NONE Please describe anything above that may impact your ability to participate in some parts of the class Are you taking medication that may impair your motor skills? Yes No Terms & Conditions * Terms & Conditions: I understand that whilst every precaution will be taken to ensure my good welfare & protection, I hereby release any and all liability in the event of an accident, misfortune, damage or loss that may occur to me &/or my property. In the case of an emergency, I hereby give permission for First Aid to be undertaken. I have & will continue to keep my Instructors fully informed of any physical condition or disability that might prevent or limit my participation. As I am responsible for my own personal health, I acknowledge that Pilates cannot diagnose or treat medical diseases or deficiencies & a medical evaluation is advised before starting any exercise program. I have read & agree with these terms and conditions. I agree FORM COMPLETE!It’s time to get to class!
