Star Pilates Client Form

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First Name *

Last Name *

Address *

City *

State *

Zip *

Email Address

Phone Number

Date of Birth

Occupation

Please indicate if you have any injuries or physical conditions which limit your ability to exercise (broken bones, surgeries, etc.)

Do you have any experience with the Pilates Method of Body Conditioning?

Yes

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If yes, with whom and how long have you been studying?

What other types of exercise or body conditioning do you do?

What goals do you wish to achieve by doing Pilates?

How did you hear about us?

Waiver

PLEASE READ CAREFULLY! WAIVER, RELEASE AND ASSUMPTION

Participant understands that Pilates involves physical exertion. Participant accepts and assumes the risks associated with Pilates including, but not limited to, equipment malfunction or failure, overexertion, and failure to properly operate equipment. Participant hereby freely and expressly assumes all risk of property damage, injury (including death), and loss associated with Pilates. Participant understands that it is his/her responsibility to consult with a physician prior to and regarding participation in Pilates. Participant represents and warrants that he/she has no physical or mental condition that would prevent participation in a Pilates program and agrees to inform his/her instructor immediately of any physical or mental condition that would prevent his/her participation in Pilates. While receiving instruction in a group, private or semi-private lessons, and using the equipment and facilities or while being instructed virtually at home, Participant hereby agrees to release, hold harmless, and indemnify Star Pilates Corporation and its owners, partners, employees, independent contractors, directors, officers, agents, and affiliates from any and all claims by or on behalf of Participant against Star Pilates Corporation arising directly or indirectly out of Participant’s participation in Pilates, use of any Star Pilates Corporation equipment or facilities, and participation in any class, program, or workshop offered by Star Pilates Corporation. This release includes claims and liabilities arising from any cause whatsoever, including, but not limited to, negligence on the part of Star Pilates Corporation. This release is binding upon Participant, and Participant’s heirs, assigns, and legal representatives.

COVID-19 LIABILITY NOTICE

I understand that while Star Pilates is following government guidelines in an effort to protect me from contracting COVID-19 and other illnesses there is a risk that I could become infected. By this Waiver, I assume any risk, and take full responsibility and waive any claims of COVID-19 associated with Star Pilates including but not limited to receiving Pilates training at the facility, using the facility and its equipment in any manner, form or fashion, and practicing and/or engaging in Pilates activities or other related activities on and off the premises.

If signing on behalf of a minor Participant, Parent/Guardian accepts full responsibility for any medical expenses incurred due to the minor’s participation in Pilates and agrees to release, hold harmless, and indemnify (including costs and attorneys fees) Star Pilates Corporation for any claims brought by or on behalf of the minor.

Please initial here that you have reviewed our waiver. *

Cancellation Policy

Star Pilates has a 24 hour cancellation policy. To avoid being charged for missed sessions please cancel with your instructor at least a day ahead of time.

Please initial here that you understand the 24 hour cancellation policy *

Please let your instructor view the form before submitting.

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