Moving Well = Being Well
Physician’s Name and Address:
I declare that I intend to use some or all of the activities, facilities, programs, and services offered by The Pilates School, and understand that each person, myself included, has a different capacity for participating in such activities, facilities, programs, and services. I am aware that all activities, services and programs offered may be educational, recreational, or self-directed in nature. I assume full responsibility, during and after my participation, for my choices to use or apply, at my own risk, any portion of the information or instruction I receive.
I recognize that there is a risk of serious injury (and in extreme cases, death) associated with any fitness program. Consequently, I was advised by the staff of The Pilates School to obtain the approval of my doctor before beginning a fitness program through The Pilates School, and have had the opportunity to do so. Before beginning this program, I also was asked by the staff of The Pilates School whether I have any physical or mental limitations, or whether I am taking any medications or receiving any medical treatment that might make it unsafe for me to participate in this fitness program. There are no such limitations, medications or medical treatment other than those that I have written on the form provided.
I understand that part of the risk involved in undertaking any activity or program is related to my own state of fitness or health (physical, mental or emotional) and to the awareness, care and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in any activity, service, and program of The Pilates School brings with it my assumption of those risks or results stemming from this choice and the fitness, performance, health, awareness, care, and skill that I possess and use.
I accept the fact that the skills and competencies of some employees, subcontractors and/or volunteers will vary according to their experience, and that no claim is made to offer assessment or treatment of any mental or physical disease or condition by those who are not duly licensed, certified, insured, or registered, and herein employed to provide such professional services.
I recognize that by participating in the activities, facilities, programs, and services offered by The Pilates School I may experience potential health risks which include, but are not limited to: transient light-headedness, fainting, abnormal blood pressure, chest discomfort, leg cramps, nausea, muscle soreness, muscle strains, and, in very rare instances, heart attack, stroke, or even death, and that I assume willfully those risks. I acknowledge my obligation to immediately inform the nearest supervising employee of any pain, discomfort, fatigue, or any other symptoms that I may suffer during and immediately after my participation. I understand that I may stop or delay my participating in any activity or procedure if I so desire and that I may also be requested to stop and rest by a supervising employee who observes any symptoms of distress or abnormal response.
I understand that I may ask any questions or request further explanation about the activities, facilities, programs, and services offered by The Pilates School at any time before, during or after my participation. I declare that I have read, understood, and agree to the contents of this informed consent agreement in its entirety.
I understand that, by signing this statement, I am agreeing not to hold The Pilates School or any of its employees, owners, agents or insurers responsible for any bodily injury or property damage that I may suffer as a result of my participation in a fitness program through The Pilates School, whether at The Pilates School, at home, or elsewhere. As such I understand and agree that The Pilates School, its employees, owners, agents or insurers shall not be liable for any bodily injury or property damage that may result either directly or indirectly from my participation in a fitness program through The Pilates School.
