Registration Form

    Select Plan:

    Fit2BarrePilates

    PART 1: PERSONAL DETAILS

    Today's Date:

    Date of Birth

    Male / FemaleMaleFemale

    PART 2: YOUR BACKGROUND AND YOUR HEALTH

    1. Does your work or sport involve any of the following?

    Sitting for long periodsBendingLifting heavy weightsDrivingStandingAny other repetitive actionNone

    2. Will this be the first time you have practised Fit2Barre / Pilates?YesNo

    3. When was the last time you took an exercise class?

    4. Have you ever been diagnosed with any sort of heart trouble or defect?YesNo

    5. Do you have high blood pressure?YesNo

    6. Are you or could you be pregnant?YesNo

    7. Have you been pregnant in the past six months?YesNo

    8. If you have given birth, how was it delivered?Natural birthCaesareanNatural with interventionNot applicable

    9. Do you often have headaches?YesNo

    10. Do you lose balance due to dizziness or do ever lose consciousness or feel faint or dizzy?YesNo

    11. Do you experience pain in your chest area when undertaking physical activity?YesNo

    12. Have you had major surgery in the past 10 years?YesNo

    13. Have you had minor surgery in the past two years?YesNo

    14. Do you suffer with asthma, diabetes or epilepsy?YesNo

    15. Have you ever been told that you have arthritic joints, osteoporosis or any bone or joint problem that may be made worse by exercising?YesNo

    16. Do you suffer from back or neck pain?YesNo

    17. Do you have pain or restricted movement in any other joints (eg hip, knee, ankle, shoulder)?YesNo

    18. Have you been diagnosed as hypermobile (excessive joint mobility)?YesNo

    19. Are there any movements that cause you pain?YesNo

    20. Are you taking any medication or drugs which may affect your ability to exercise?YesNo

    If you have answered yes to any of the questions 4 – 20 above, we advise that you consult your medical practitioner before you start Fit2Barre / Pilates classes.

    PART 3: YOUR AIMS

    What are your reasons for taking up Fit2Barre / Pilates classes?

    What health or physical goals would you like to achieve over the next three months?

    What longer – term health or physical goals would you like to achieve over the next 12 months?

    PART 4: GENERAL INFORMATION

    Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes.

    It is inadvisable to do Fit2Barre / Pilates classes between weeks 8 – 14 of pregnancy, unless by special arrangement with your teacher. We also recommend that you wait for 6 weeks after the birth before resuming exercise.

    Fit2Barre / Pilates exercises are very safe but, as with all forms of physical exercise, it is prudent to consult your doctor before starting Fit2Barre / Pilates sessions.

    These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises you should refer back to your medical practitioner. The teacher cannot accept 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. Please also inform the teacher if you felt any discomfort after a previous session.

    I understand that Fit2Barre / Pilates exercises involve hands-on correction and I hereby consent for my teacher to work in this way.

    PART 5: COVID-19 CONSENT FORM

    1. Have you been in contact with anyone displaying signs or symptoms of illness or COVID-19 in the last two weeks?YesNo

    2. Have you displayed any signs or symptoms of illness or COVID-19 in the last two weeks?YesNo

    3. Have you travelled outside of your home region in the last two weeks?YesNo

    By ticking this box, I state that I have been screened for COVID-19 by Donnamarie Fitness and confirm that should I answer yes to any questions related to PART 5: COVID-19 CONSENT FORM I may be asked to join a Zoom class instead of in person.
    If you have had a COVID-19 test for any reason whether you have symptoms or not, please refrain from attending your class until a negative result is obtained.

    I confirm that I have read and understood the above advice and that the information that I have given is correct. This will be used to develop my personal Fit2Barre / Pilates programme.