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Physio & Pilates - Ease Your Movement

Client: Health Declaration | Participation Waiver

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Emergency Contact Name

Emergency Contact Number

Please Complete

I confirm that I am medically fit to participate in physical exercise

I have disclosed all relevant medical conditions, injuries, surgeries, pregnancy, or physical limitations

I understand that it is my responsibility to inform the instructor of any changes to my health

I have a medical condition/injury/medication

I understand that Pilates, physiotherapy-based exercise, and movement training involve physical activity that carries a risk of injury.

By signing this waiver, I confirm that:

I voluntarily choose to participate in classes, private sessions, workshops, or online sessions
I understand that participation is at my own risk
I agree to follow all instructions and safety guidance provided by the instructor
I accept responsibility for stopping any exercise that causes pain, dizziness, or discomfort

Participation & Assumption of Risk

I acknowledge that Physio & Pilates, its instructors, and affiliates are not responsible for injuries resulting from failure to follow instructions or failure to disclose relevant health information.

Online Sessions (If Applicable)

For online sessions, I confirm that:

I have adequate space and a safe environment to exercise.

Release of Liability

I understand that online classes are not suitable for acute injuries or new pain unless cleared by a qualified healthcare professional.

Photography & Video (Optional)

By signing this document, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.

Single choice

I consent to photographs or videos being taken for educational or marketing purposes

I do NOT consent to photographs or videos being taken

You may withdraw consent at any time by notifying us in writing.

Declaration & Signature

I confirm that the information provided above is accurate and complete.
I have read, understood, and agree to the terms of this waiver.

Name (Printed)

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Year

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