Registration Form

    Contact will only be made to update you on future Pilates courses and offers, evaluation purposes and in the event of any class cancellations.

    Emergency contact (Next of kin) in case of an emergency. Please notify:

    Previous experience

    *For community classes you are required to bring your own mat. Class is done bare foot so recommended for hygiene reasons

    Please complete the below health questionnaire to help us identify any on-going health issues we should be aware of.

    This questionnaire is designed to identify whether it is appropriate to undertake an exercise programme. If you are between 15-69 yrs, it will tell you if you should check with your doctor prior to taking part in any activity. If you are over 69 yrs and inactive please check with your doctor prior to commencing any programme.

    Please tick and provide information if yes. Selections with * may require further information and can be entered in the box below.

    (for example; physical, learning or visual) that we may need to be aware of and take into account when planning and delivering services, to make reasonable adjustments for you.

    (including any physical restrictions or injuries)? If so have you been cleared by your Dr?

    If you have answered Yes to one or more questions, please check with your doctor/midwife whether it is safe for you to undertake a new exercise programme. Please highlight to them the questions to which you answered yes and follow his/her advice. In some cases it is necessary to restrict the client from activity which can potentially cause greater problems. If any of the circumstances change please notify your instructor who will be able to advise you accordingly.

    By signing this form you are agreeing that the above information is correct and that you will notify BActivePilates if your details change in future, including changes to your health and medical information. We accept no liability for any personal injury, property damage/loss or death. We may request to take a photo headshot at your first class.

    Please print name.

    On occasions we may capture photographs of the class which may be shared on our social media channels and website for future promotional purposes. If you do not wish to be included in any photographs taken please do inform us.

    By registering with BActivePilates you will be subscribed to the BActivePilates mailing list to keep updated on our services. Please see our Privacy Policy for further details.