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Your Health Waiver

First name*

Last name*

Email*

Phone*

Birthday*

Day

Month

Year

Gender*

Emergency Contact Name*

Emergency Contact Phone*

Medical Questions

Answer the following questions as honestly as you can and provide as much relevant additional information. Answer by placing a tick next to any conditions that apply to you (if you should answer YES to any of the questions please provide further information in the space provided).

Do you currently or have ever suffered from any of the following conditions?*

Heart problems?

Circulatory problems?

Blood pressure problems?

Joint or movement problems?

Feel dizzy or imbalance during exercise?

Currently pregnant or given birth in the last 6 months?

Other

None of the above

If you ticked YES to any of the previous questions, please provide details.

Do you currently receive medical care for, or are affected by any of the following conditions?*

Back / spinal pain?

Headaches or migraines?

Have you recently had surgery?

Currently being prescribed medication?

Recently finished a course of medication?

Diabetes?

Asthma or breathing problems?

None of the above

If you ticked YES to any of the previous questions, please provide details.

Is there any other reason that you believe may prevent you from taking part in any regular activity?*

Declaration

By signing this document, I confirm that I have completed this health waiver honestly and to the best of my knowledge. I understand that it is my responsibility to inform the studio and my instructor immediately if there are any changes to my health, medical conditions, or physical capabilities that may affect my ability to participate in exercise. In such an event, I agree to complete and submit a new health waiver before continuing with any further sessions.

I acknowledge and accept that participation in Pilates involves inherent risks, and I voluntarily assume all risks associated with my participation. I understand that Renu Studios and its instructors are not responsible for any injuries, damages, or losses that may occur as a result of my participation in classes, whether due to my pre-existing conditions, failure to disclose health information, or any other cause.

Signature*

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