New Client Form

Please fill out this form before taking your first class or 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?
Please check all the following that currently apply to you:
Infrared Sauna *
I acknowledge and accept the risks inherent in the use of the Infrared Sauna. I voluntarily assume the risk of injury, accident or death, which may arise from the use of the Infrared Sauna. As a condition of using the Infrared Sauna, I hereby release Reforming Foundations Pilates & Wellness LLC from all claims or liabilities for personal injury or property damages of any kind sustained while using or in connection with the Infrared Sauna. I acknowledge that this release applies to and is binding upon any of my heirs, executors, representatives or assigns. I further acknowledge and agree that use of the Infrared Sauna is for comfort only and the employees, independent contractors, representatives or agents of Reforming Foundations Pilates & Wellness LLC do not condone the use of the Infrared Sauna for purposes of curing ailments or disease or any other medical benefit. I agree that this Application and Waiver is in effect for all Infrared Sauna sessions and will not expire unless express written notice is given to a Managing Member of Reforming Foundations Pilates & Wellness LLC, at which time access to the Infrared Sauna will be terminated.
Cancellations and Policies *
Please provide a minimum of 24 hours notice of cancellation. We understand emergency situations arise and promise to be considerate of any personal emergency; however, Reforming Foundations Pilates and Wellness LLC runs and maintains an active facility serving many customers and we expect all our patrons to be respectful of our commitment to scheduling the resources of the facility in an efficient and accommodating manner. Prior to any training session, a Health Information and Waiver of Liability must be completed. Sessions and classes are 50 minutes. Sessions will begin and end promptly as scheduled, and under no circumstances will any form or flirting, touching, fondling, or other affectionate advances toward any staff member at Reforming Foundations Pilates; Wellness LLC be tolerated. Any form of harassment, be it verbal, sexual, physical or emotional is cause for immediate termination of services. The physical touching or tactile cueing associated with training sessions may require the instructor or trainer to work in close proximity to the trainee or client and often requires the instructor or trainer to be in the client’s personal space. The physical touching and tactile cueing is for the purposes of the instruction and safety of the client and should never be construed as an invitation for romantic or sexual advances. Any act, touch, comment or innuendo, directed by a client toward an instructor or trainer, regardless of whether well intentioned by the client, is grounds for immediate termination of services; further, any harassment of any member of the team at Reforming Foundations Pilates & Wellness LLC that rises to the level of a criminal act will be prosecuted to the full extent. To keep you safe and our studio clean, grip socks or studio fitness shoes are required. Payment is due at time of service. Packages expire 12 months after activation. Please set your phone so as not to disturb others. Please refrain from wearing scents or perfume.
Liability Waiver *
I understand that it is my responsibility to consult with a physician prior to my participation in any class or other activity associated with or offered through 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 any class, health program or workshop offered by Reforming Foundations Pilates & Wellness, whether onsite at their Berkley location or offsite at another location. I recognize that the classes and/or sessions provided by Reforming Foundations Pilates & Wellness LLC will require physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. Pilates instruction involves physical touch; I consent to methods of tactile cueing. 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; moreover, I expressly agree that if at any point during any instruction or training session I feel the exercises, movements or cues are beyond my physical ability I shall immediately stop the session and advise the trainer or other professional of Reforming Foundations Pilates & Wellness LLC. 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 and I voluntarily accept these risks. 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, regardless of the foreseeability of the potential for injury. Further, I will indemnify and hold harmless Reforming Foundations Pilates & Wellness, LLC, its members, officers, agents, employees, and independent contractors 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. I have read and fully understood the liability waiver and voluntarily agree to all the terms and conditions stated herein.
Consent To Photograph & Authorization For Use or Disclosure
In consideration of the mutual covenants contained herein authorize my photograph/video taken of me by Reforming Foundations Pilates & Wellness, LLC, to be reproduced for the purpose(s) of educational, editorial, illustration, advertising, or trade, in digital, print or other publication format, or for any social media channel of Reforming Foundations Pilates & Wellness LLC; and hereby release and discharge Reforming Foundations Pilates & Wellness LLC, its employees, officers, representatives or agents, from any and all suits, causes of action, claims, demands or obligations of any kind arising out of the reproduction of my photograph/video for the above stated purposes. I expressly authorize Reforming Foundations Pilates and Wellness LLC to use my likeness or image regardless of whether said use results in a commercial benefit to Reforming Foundations Pilates & Wellness LLC. If at some point I wish to revoke this authorization for the use of my likeness or image, I agree I shall provide written notice to a Managing Member of Reforming Foundations Pilates & Wellness LLC expressing said revocation. I acknowledge that I have read, and understand, the release and indemnification provisions set forth in the preceding paragraph, and agree to such terms.
Please type your full name. Your actual signature will be taken at the time of your session.
Today's Date *
Today's Date
I consent to the above conditions.