Physio & Pilates Clinic

PARTICIPATION WAIVER | HEALTH DECLARATION

Please fill out the following form.

First Name

Last name

Phone

Email

Date of birth

Day

Month

Year

Emergency Contact

Contact Name

Multi choice

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

None

Other

Please Tick ✔ all that apply

Participation & Assumption of Risk

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

I acknowledge that Physio & Pilates Clinic, 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
I understand that hands-on corrections cannot be provided
I accept full responsibility for my safety during online participation

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

Release of Liability

To the fullest extent permitted by law, I hereby release and hold harmless Physio & Pilates Clinic, its owners, instructors, employees, and contractors from any claims, demands, or liability arising from my participation in any session, whether in-studio, online, or off-site.

Photography & Video (Optional)

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 the clinic in writing.

Declaration & Signature (Adults)

I confirm that the information provided above is accurate and complete.

I have read, understood, and agree to the terms of this waiver.

Name

Initials

Date

Day