NEW CLIENT FORM

Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday *

MM

DD

YYYY

Sex *

Male

Female

Other

Emergency Contact Phone Number *

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Please check all of the following that apply to you (past and current conditions) *

Allergies

Arthritis

Artificial joints

Artificial valves

Asthma

Autoimmune Disease

Back pain

Blood clots

Broken bones

Bulging/herniated discs

Bursitis

Cancer

Diabetes

Diastasis (from Pregnancy)

Dizziness

Epilepsy/seizure

Fatigue

High Blood Pressure

Heart disease

Hernia

HIV

Low Blood pressure

Neck pain

Numbness

Osteopenia

Osteoporosis

Pregnancy

C-section

Sciatica

Scoliosis

Stenosis

Spondylosis

Spondylolisthesis

Stroke

Hyperthyroidism

Hypothyroidism

Studio Policies and Cancellation Policy *

Studio Policies, Refunds, and Cancellation Policy Payment is due at the time of service or before. There will be NO REFUNDS or EXTENTIONS for any unused session on a purchased package. All packages have an expiration date. The 5 session package expires in 2 months, the 10 session package expires in 4 months. All sessions are 50 minutes. Clients who arrive late or leave early from a scheduled appointment will not pay a reduced fee. The trainer will wait for 30 minutes after the scheduled appointment time, after which the trainer is free from the appointment obligation and the client is charged the full amount for the appointment. Cancellation Policy: A Body of Work has a 24-hour Advance Notice Cancellation policy. All appointments canceled less than 24 hours in advance will be considered a Late Cancel and full payment for the session will be applied. Any changes to an appointment must be made at least 24 hours in advance or you will be charged for a late cancel. Standing Appointments: It is understood that standing appointments are an on-going commitment. These appointments are held in reserve for the client and the client is responsible for these appointments unless the client cancels at least 24 hours in advance or states their desire to terminate the standing appointment reservations at their last session. Cell Phones / Fragrances/ Socks: We request that you do not wear perfume or strongly scented lotion or fragrance to the studio in consideration of other clients’ environmental sensitivities. Cell phones must be silenced when in the studio. Please wear socks at all times in the studio.

I agree

Standing Appointment Policy

Standing appointments: Clients with regularly scheduled private or duet sessions, at least once per week, are considered standing appointments. Clients with standing appointments are required to maintain a credit card on file to retain standing appointments. A Body of Work will automatically process payments for clients with standing appointments, using the cc on file, unless client gives ABOW at least one week’s notice of terminating their standing appointment. Packages for clients with standing appointments will be automatically renewed with the same quantity of sessions as the most recently used package.

I Agree

Informed Consent and Liability Waiver *

I understand that it is my responsibility to consult with a physician prior to my participation in any group class, session, or other activity associated with or offered through A Body of Work. I represent and warrant that I am physically fit and have no medical conditions that would prevent my full participation in any class, session, or workshop offered by A Body of Work. I recognize that the classes and/or sessions provided by A Body of Work will require physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that Pilates, Gyrotonic, and Functional Fitness instruction involves physical touch; I consent to methods of tactile cueing. I hereby give my consent to receive manual cueing and therapy from A Body of Work and I acknowledge and agree that I am doing so at my own risk; moreover, I expressly agree that if at any point during any instruction or training session I feel the exercises, movements or cues are beyond my physical ability I shall immediately stop the session and advise the trainer or staff at A Body of Work. My health and safety with respect to such services are my sole responsibility. Virtual instruction: In the event that I opt for virtual instruction via Zoom, facetime, or other video communication, I expressly agree that I am fully aware of the additional risks in practicing Pilates, Gyrotonic or Functional Fitness without the benefit of an instructor’s physical presence. I recognize that I will not have the benefit of tactile cueing or the instructor’s ability to physically guide me through a movement that is new to me or correct a movement that I am executing incorrectly. I expressly agree that if at any point during virtual instruction the training exceeds my abilities or skill level, I will stop immediately and communicate my limitations to the virtual instructor. Additionally, I acknowledge that my own video or audio recording of the virtual instruction classes or session is expressly forbidden, whether for personal use, commercial, or even merely sharing on social media outlets. A Body of Work retains all property rights to any video in which an instructor from A Body of Work appears, directs, instructs, or voices over. It is expressly agreed that all use of the Studio facilities and Studio equipment shall be undertaken by clients at his/her own sole risk. It is also expressly agreed that A Body of Work and the Trainer shall not be liable for any injuries or any damages to client or guest, or be subject to any claim, demand, injury, or damages whatsoever, including without limitation, those damages resulting from acts of active or passive negligence on the part of A Body of Work, its agents or officers, or Trainer. A Body of Work reserves the right to refuse service to any client, guest, or person who appears unable to perform our services due to any physical or psychological reason including the use of alcohol, drugs, medication that alters one’s cognitive and/or physical abilities, or any other condition that may put that person and/or the studio and its trainers or staff at risk.

I have read and fully understand the liability waiver and agree with all the terms and conditions stated herein.

I have voluntarily chosen to participate in a Physical Exercise Program at A Body of Work.

Photography and Video Release Waiver *

I hereby grant A Body of Work e and ITT Pilates permission to use my likeness in a photograph or video clip in any and all publications, including A Body of Work or ITT Pilates websites and social media outlets, without payment or any other consideration. I understand and agree that these materials taken during my classes, sessions, or visits to A Body of Work will not be returned. I hereby irrevocably authorize A Body of Work to edit, alter, copy, exhibit, publish or distribute photos or videos taken during these classes and sessions, for the purpose of publicizing A Body of Work and ITT Pilates programs. I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of these photographs and video clips. I hereby hold harmless and forever discharge A Body of Work and ITT Pilates from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I agree

I do not agree

Today's Date *

MM

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I consent to the above conditions.

I agree