Health Questionnaire — Olivia Newstead

Email

Ocupation:

Emergency Contact Details

Please give their Full Name and relationship to you

How did you hear about Pilates classes with Olivia

Website, Social Media, Word of Mouth etc.

If you have selected one or more of the above conditions, please give details. Or if there's anything in your medical history that could affect your ability to exercise or likely to cause you concern whist participating in an exercise class, please give details.

Eg. If you are on any medications which may affect your ability to exercise, how far along in pregnancy, etc.

If you have selected any of the above and are concerned about doing exercise, please speak to your GP before starting an exercise programme

If you have answered no to all questions you can be sure that you can start to become more physically active and take part in a suitable exercise programme. Do begin slowly and build up gradually By taking part in a Pilates class and signing this declaration you are confirming that you have read and understood this PAR-Q form. Participants take part in exercise at their own risk. If your doctor has recommended that you avoid any particular exercise, please make sure you inform your Pilates instructor. If your health changes subsequently so that you answer YES to any of the above questions, please inform your instructor immediately. I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way. I confirm agreement for my teacher to contact me with information on classes and other Pilates-related activities, and understand that I have the right to withdraw this ‘consent to be contacted’ at any time. SIGNED (Please sign or print your full name below)