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Physio & Pilates - Ease Your Movement

Cient: Parent | Guardian Consent Form

This form must be signed by a parent or legal guardian of participants aged from 6 to 16 years old.

If Applicable

If Applicable

Date of birth (Participant)
Day
Month
Year
Date of birth (2nd Participant)
Day
Month
Year

If Applicable

School Information

Parent(s)/Guardian(s) Details

Alternative Drop Off/Pick Up Arrangement

Please list details of any other responsible adults who have the right to drop off and pick up the participant(s) below:

Consent given for participant to arrive/leave on their own?
Arrive
Leave
Neither

For ages 10 -16 with an authorised adult.

Medical Information of Participant

You agree to notify Physio & Pilates of any changes to the medical information set out in this form.

The participant has medical needs
No
Yes
The participant has allergies
No
Yes
The 2nd participant has medical needs
No
Yes

If Applicable

The 2nd participant has allergies
No
Yes

If Applicable

Parent/Guardian Consent

PLEASE READ THE FOLLOWING CAREFULLY


• The studio does not accept participants younger than 6 years old. 


• Only the Parent, Guardian, or Responsible Adult aged 18 or over listed in this Consent Form (“Authorised Contact”) can collect the participant from the studio unless the participant is aged between 10 and 16 years, in which case the participant may leave the studio on their own with the Authorised Contact’s prior consent.


Participants aged over 16 may leave the studio on their own without prior consent of an Authorised Contact, unless we are advised to the contrary.


• You agree to provide us with up-to-date contact details for all Authorised Contacts.


• As you will appreciate, we often have classes running back-to-back or other commitments outside of the studio. For this reason, we value punctuality when collecting participants at the end of the class.

We appreciate that from time to time unforeseen events may arise, we therefore have the following arrangements in place so that everyone is aware of the steps that we will take if you are late.


For participants aged 16 and under where prior consent has not been given to leave the studio on their own:


• If you will be more than 5 minutes late collecting the participant, please inform us in advance (if possible) or contact the studio to notify us as soon as you can.


• If you are more than 5 minutes late and we have not been notified, we will contact you or an alternative Authorised Contact to collect the participant.


• If you or an alternative Authorised Contact does not collect the participant within 10 minutes of the class ending, we reserve the right to charge a late pick-up fee of £65 (being the cost of one private session with the studio).


• If, after 30 minutes, the participant has still not been collected and we have been unable to contact you or an alternative Authorised Contact, then we may contact the police and we will follow their instructions, which may include making contact with the local authority social services. In such circumstances, we reserve the right to charge additional sums to cover any costs, expenses or losses we incur arising out of the delay in collecting the participant.


• Participants cannot attend a class if they are unwell. If, in the opinion of a class teacher, a participant is or appears to be unwell, we will contact you or an Authorised Contact and request that the participant be collected as soon as possible. In the event of an emergency, Body Principles may contact the emergency services or the doctor’s surgery detailed above.


• We will not administer any medication. If a participant has medical needs that require prescribed medication, an Authorised Contact must remain in attendance at the studio for the duration of the class to administer the medication if required.


• Save as otherwise set out above, our standard Terms and Conditions apply to children’s classes, including our cancellation policy.


I agree to my child receiving every medical, dental and surgical treatment deemed necessary by the medical and other qualified personnel advising at the time. I understand that Physio & Pilates will try to contact me immediately (or another appointed Authorised Contact) in any such event, but that in an emergency, decisions may need to be taken in my absence.

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