BOOK YOUR SESSION Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Which session are you interested in? * Private Session Duo Trio Emergency Contact * First Name Last Name Emergency Contact Number * (###) ### #### Treatments/Medications * Regular Physical Activities * Previous Number of Pilates Sessions * With whom First Name Last Name Individual Goals * How did you hear about us? Option 1 Option 2 Disclaimer * I understand the various riskes associated with an exercise program and it is my desire to participate. I have not withheld any relevant information regarding my physical condition, which may affect me during or following a session. I agree that Highline Pilates and its instructors are not responsible for any injuries sustained during my exercise sessions and hereby release them from any responsibility. I have read and understand Highline Pilates' polices and procedures. I agree Today's Date * MM DD YYYY Do you consent to being photographed for Highline Pilates' website/social media pages? * Yes No Thank you!
