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Enrolment Form

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PERSONAL INFORMATION

Name

YOUR HEALTH AND BACKGROUND

1. Have you had hypnotherapy or visualisation therapy before?
2. Do you have any health condition(s) which you think may be relevant?
3. Do you have any specific fears or phobias?
4. Do you have any other health condition(s) which you think may be relevant?
5. (If attending a workshop) Will this be the first time you have practised Pilates?
6. (If attending a workshop) Do you have any medical conditions and or Injuries that prohibit exercise?
7. (If attending a workshop) Have you ever been told by your doctor that you cannot exercise?
8. (If attending a workshop) Do you have restricted movement in any of your joints? (e.g. Hip, Knee, Wrist)
9. (If attending a workshop) Are there any movements that cause you pain?
10. Are there any other reasons your ability to exercise may be affected?
11 Have you been recommended or referred if so please give details.

IMPORTANT INFORMATION For classes, workshops & retreats.

These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of any aspects of the session or the exercises, you should refer back to your medical practitioner.

The teacher can accept no liability for personal injury related to participation in a session if:

  • Your doctor has, on health grounds, advised you against such exercise
  • You fail to observe instructions on safety or technique
  • Such injury is caused by the negligence of another participant in the class/studio

Exercise should be performed at a pace which feels comfortable for you. Pain is the body’s warning system and should not be ignored. Please inform your teacher immediately if you feel any discomfort during a session or after a previous session.

I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way.

I confirm that I have read and understood the above advice and that the information I have given is correct.

I confirm that my teacher may use the contents of this form, and any other information I may later provide, for teaching purposes, and that this information:

  • will be used in confidence and stored securely
  • will not, in any circumstances, be shared with a third party without my written consent, unless that party is another (Body Control) Pilates teacher who will teach me.
  • may be retained by the teacher for a period of time such as complies with professional, legal and insurance requirements that they must fulfil

I DO/DO NOT (please delete) consent to any photos and videos taken of myself during class to be used on social media, for advertisement or any public platform. *

I DO/DO NOT (please delete) consent to any photos and videos taken of myself during class to be used on social media, for advertisement or any public platform.

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NKM Therapies

I am a qualified Clinical Hypnotherapist Therapist and Talking Therapist registered with the NCH, GHR, ACCPH & CNHC.

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