Please complete the following form, then sign the client release below.

    Please give us some details about your physical history, including any injuries, ailments, illnesses, surgeries, pregnancies, and any significant medical treatments. Check all body parts that are involved.

    Now add your signature to the release below

      Waiver of Liability and Informed Consent Release

      I, the undersigned, have voluntarily enrolled in a program or instruction in the Pilates Method of physical conditioning offered by Island Pilates as a participant, I understand and agree that:

      1. Participation in this or any exercise program and conditioning activity may cause injury, especially to those with pre-existing injuries, illnesses, conditions and mental disabilities.
      2. The use of the exercise equipment at Island Pilates carries with it a risk of injury to myself and to others and I will use such equipment and facilities with due care.
      3. Many changes may occur as a result of these exercise lessons, including possible short-term aggravation of symptoms, tiredness, light-headedness, increased energy, mood changes etc.
      4. A medical evaluation is recommended before commencing any form of physical conditioning or exercise.
      5. I have or will continue to keep Island Pilates fully informed of any physical condition or disability, which could prevent or limit my participation in an exercise or physical conditioning program.

      In consideration of my participation in the Pilates Method and other exercise programs at Island Pilates and my use of the exercise equipment provided by Island Pilates, I hereby expressly agree and contract, on behalf of myself, my heirs, personal representatives and assigns, that Island Pilates, its employees, directors, and consultants shall not be liable for any damages arising from my use of the exercise equipment or in connection with my participation in the exercise program. By execution of this Waiver, I expressly assume all risks of physical injury, illness, damage or loss to me and my property related to, associated with or resulting from my participation in the Pilates Method and any other exercise program conducted by Island Pilates and fully and forever release and discharge Island Pilates, its employees, directors, and consultants, from any and all claims, liabilities, demands, damages, rights of action, or causes of action, present or future.

      CANCELLATION POLICY: I understand that if I must cancel a scheduled appointment, I must notify Liz Knibbs operating as Island Pilates at least 24 hours in advance or I will be held responsible for payment in full.

      I, the undersigned, have read, fully understand and agree to the aforementioned.

      And lastly, use your finger, mouse or stylus to sign below. This can be a bit tricky, so use the "Clear" button if you need to start again.