Pilates Screening Form

I desire to engage voluntarily in a Pilates exercise program given by Flow Physical Therapy and Pilates. I understand that the activities may be strenuous, and may require me to do body movement that I am not familiar with in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workouts. Should any unusual symptoms occur, I will notify the Pilates instructor and temporarily cease my participation.

I understand that Pilates can at times involve verbal and tactile cues. Tactile cues are used for alignment correction and proper execution of Pilates exercises. If I wish tactile cues to be withheld, I will this request in written form.

In signing this consent form, I affirm that I have read, accept and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with Pilates’ fitness classes and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety.
I take full responsibility for my own health and safety in participating in the Pilates fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities.

By checking the box to agree with this statement, I am submitting this as my signature.