Kids Pilates with M.E. Indemnity Form

Parent's Information

Next of kin details

Child Details

Please list your children's names, ages and any sport, activity or treatment they're receiving

General Information

How did you hear about my studio or who referred you to me?
What are your goals?
What do you want most from this Pilates program?
Please describe your children's current level of physical activity?
Have your children had any past training in the Pilates method?
If yes,where?
Are your children presently doing other kinds of therapy?
eg massage, physio, chiro etc?
Do your children have any injuries, aches or pains, recent or old?
If so please describe.
Are there any other health concerns regarding your children?
e.g asthma, diabetes, high blood pressure, medications, etc

Level of Commitment

How many times a week would your children like to do Pilates?

Terms & Conditions

If your children are under a doctor's care, please supply me with a note from the doctor stating that they are able to start this exercise program.
Whilst I take every possible care, your children, as a members of KIDS PILATES WITH ME will utilise the facility entirely at their own risk and you, as their guardian, expressly indemnify KIDS PILATES WITH ME against any claim you may have against KIDS PILATES WITH ME and or my staff whatsoever cause arising.

By ticking the box below you agree to my Terms & Conditions listed here
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