Elite Client Form

Please fill out this form before taking your first private session.

Name *
Name
Text Appointment Reminders *
Phone *
Phone
Mobile Provider *
Emergency Contact Number *
Emergency Contact Number
Have you had any experience in the Pilates method of movement?
May I contact him/her to collaborate?
Cancellations and Policies *
Please provide a minimum of 24 hours notice of cancellation.  To keep you safe and our studio clean pilates grip socks are required.  Payment is due at time of service.
Liability Waiver *
I understand that it is my responsibility to consult with a physician prior to and regarding my participation in this class or any other activity associated with Reforming Foundations Pilates & Wellness LLC. I represent and warrant that I am physically fit and have no medical conditions that would prevent my full participation in the class, health program or workshop. I recognize that this class and/or session will require physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. Pilate’s instruction involves physical touch; I consent to methods of tactile cuing. I hereby give my consent to receive manual therapy from Reforming Foundations Pilates & Wellness, LLC, and I acknowledge and agree that I am doing so at my own risk. My health and safety with respect to such services are my sole responsibility. I acknowledge that my receipt of the services from Reforming Foundations Pilates & Wellness, LLC, may result in bodily injury or death. My decision to receive services from Reforming Foundations Pilates & Wellness, LLC, is voluntary, and I know of, understand and assume any and all the risks associated therewith. In exchange for receiving services from Reforming Foundations Pilates & Wellness, LLC, I, for myself and on behalf of my heirs, executors, administrators and personal representatives, hereby waive, release, discharge and hold harmless Reforming Foundations Pilates & Wellness, LLC, its members, officers, employees and agents from any and all liability for any and all injuries, including death, damages or claims relating to or resulting from my receipt of the services, now or in the future, foreseen or unforeseen. Further, I will indemnify and hold Reforming Foundations Pilates & Wellness, LLC, its members, officers, agents and employees, independent contractor harmless from and against any and all claims, rights, damages, liabilities, losses, costs and expenses (including reasonable attorneys’ fees) arising from or in connection with any injuries to other persons or damage to property caused by or attributed to me. I acknowledge that I have read, and understand, the release and indemnification provisions set forth in the preceding paragraphs, and I agree to the terms in the liability waiver.
Please type your full name. Your actual signature will be taken at the time of your session.
Today's Date *
Today's Date