Name* First Last Address Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Permission to contact you via email*YesNoDate of Birth DD MM YYYY Emergency Contact NameEmergency Contact PhoneHave you done pilates before?YesNoWhere / When?Specify your health and fitness goalsWhat other forms of exercise do you do, current and/or past, and frequency:Please outline any injuries or pain that you may haveAre you currently receiving care from any of the following?Please tick if relevant Physical Therapist Chiropractor Physician Massage Therapist Other Studio Policy*Cancellations: 24-hour notice must be provided or session/class will be charged. To be fair to all instructors and clients, no exceptions can be made. (Please no requests). Cancellations can be made via phone, online or email. Make-ups: 1 make-up class per month is offered for any late (charged) cancelled class. This is to be used within one month. Additional late class cancellations cannot be made up. Payments: due by the first session of the new package. Expirations: One month for single sessions. Five session packages expire/have seven weeks to be completed. Ten session packages expire/have fourteen weeks to be completed. Refunds/Credits: refunds are not available. Pilates Reformer: should there be only one person in a session it will be reduced to a thirty-minute one-on-one instruction. I understand the following and agree to abide by all SMART Pilates studio policies Client Signature*Agreement*This release, Waiver and Hold Harmless Agreement, is made by and between the undersigned (client) and SMART Pilates, and entered into on the day, month and year noted below. SMART Pilates provides for instruction in Pilates and other exercise methodologies. The parties to this agreement recognize that while Pilates and other exercise is not strenuous, participation in the activity could lead to physical injury to the client. Client desires to undertake the SMART Pilates program with the full knowledge of the possibility that physical injuries could result from it and desires to assume the risk of any such injury. The parties recognize that SMART Pilates will not be able to and will not provide its program to the client without the execution of this agreement and our detailed client profile. Therefore client, in consideration of the above and of the exercise classes to be provided, hereby waives all claims for damage or loss to person or property which may be caused any act, or failure to act, of SMART Pilates instructors, staff, landlord, and their officers, agents or employees. Client assumes the risk of all dangerous conditions in and around the premises and waives any and all specific notice of the existence of such conditions. Client also assumes the risk of any and all injuries that might result from participating in SMART Pilates exercise programs. In consideration of my participation in SMART Pilates exercise program, I, (client name), for myself, my heirs and assigns, hereby release SMART Pilates, its employees and owners, from any claims, demands and causes of action arising from my participation in the exercise program. I hereby affirm that I have read and fully understand the above, am over eighteen years of age. I agree Client Signature*PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.