Name *

First Name

Last Name

Pilates Experience

Beginner

Tried before

Experienced

Please tick if you suffer from any of the following...

Past Major operations

Back Problems

Joint Problems

Neck Problems

Please tick if you have any of the following conditions...

High Blood Pressure

Heart Problems

Asthma

Headaches

Diabetes

Breathing Problems

Epilepsy

Are Pregnant

Angela Routledge Pilates will not accept liability for any damage or loss to personal property bought into the class. Angela Routledge Pilates shall not be liable for personal injury while in the meeting room unless it can be proven that it relates to a wilful act, neglect or default of a member of Angela Routledge teaching staff. It is the responsibility of each client to ensure they are capable of performing the exercises and do so at their own risk. Every effort is made by Angela Routledge Pilates to deliver safe, effective and enjoyable classes and your personal feedback is always extremely welcomed. *

Agree

ANGELA ROUTLEDGE PILATES DATA PROTECTION POLICY 1. All personal information that is collected from you will be used solely by Angela Routledge Pilates and fully trained practitioners and kept filed securely in accordance with the Data Protection Act 1998. You reserve the right to request a copy of all data that is held about you at any time. 2. All new class participants are required to fill out and sign a Health Assessment Questionnaire either online or a paper copy at class. These forms are securely stored and are only accessed by Angela Routledge for Angela Routledge Pilates. At the beginning of each term, if you have notified us that you are leaving or have unsubscribed from the mailing list, your online forms will be deleted and paper forms will be destroyed. 3. For the purposes of communication about the classes, timetable changes, events, updates and class cancellations I ask every participant for an email address. This is the only form of data necessary apart from the signed Health Assessment Questionnaire. Supplying your email address is not obligatory. However without your contact information it is not possible to contact you about class changes or cancellations. 4. All email addresses are entered on to a secure mailing system. There is a link available to unsubscribe on every email sent. NO email addresses are passed on to any one person or third party companies. *

Agree