Date of birth *

MM

JJ

AAAA

Name *

Prénom

Nom de famille

Mobile *

Pays

(###)

###

####

Address *

Adresse 1

Adresse 2

Ville

Région/Province

Code postal

Pays

1. Has your child’s pediatrician ever said that your child has any sort of heart trouble or defect? *

NO

YES

2. Is there any part of your child's medical history that we should be aware of, or that might affect your ability to perform certain exercises (e.g., asthma, dizziness, chest pain, etc.)? *

NO

YES

3. Has your child had any operations or injuries in the last year? *

NO

YES

4. Does your child suffer from backache? *

NO

YES

5. Are there any movements or areas of the body that cause your child pain (e.g., raising your arms, bending forward or to the side, etc.)? *

NO

YES

6. Is your child taking any medication that we should be aware of? *

NO

YES

Please indicate that you have read and understand the following terms and conditions. *

*** If you answered YES to any of the questions, we advise you to consult a doctor BEFORE your child starts a new physical activity. *** Please advise the Instructor before each class if for any reason your child's ability to exercise has changed. Pilates exercises and Yoga are very safe but, as with all forms of physical exercise, if you have any doubts about the suitability of the exercises, you should refer to your medical practitioner. The Instructor can accept no liability for personal injury related to participation in a class if a) Your doctor has advised you against such exercise; b) Your child fails to observe instructions on safety or technique; or c) Such injury is caused by the negligence of another participant in the class. Please let us know if your child is unable to attend the class. Classes cancelled less than 24 hours in advance will be charged to you. Please consult the conditions on our price list.

I have read and understand the terms.