STUDENT INTAKE FORM

Welcome to Pilates @ The Studios! We ask that you take a few minutes to fill out this form. Students are also welcome to print this page and bring to class. All information will be kept confidential.

Name *
Name
Date *
Date
Phone *
Phone
Address *
Address
Emergency Contact Phone *
Emergency Contact Phone
Present Health Condition:
Please Check All That Apply
(cardiovascular, seizures, stroke, etc)