Pilates of Scottsdale FormsNew Client FormsWelcome to Pilates Institute of Scottsdale & Paradise Valley! Please complete this secure form so that we can better serve you. We respect your privacy and we never share your information with anyone!Please enable JavaScript in your browser to complete this form.Client Information - Step 1 of 4Name *FirstLastAddress *Address Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone # *Please enter the best number to reach you.Email *We will NEVER share your information!Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital Status *Single/UnmarriedMarriedDivorced/Widowed/SeparatedCurrent Height *Current Weight *Name of who to contact in case of emergency *Emergency Contact Phone # *How did you hear about Pilates Institute of Scottsdale? *Website/GoogleRelative/FriendBusiness AssociateBrochureNewspaper/MagazineSpecify which website or magazine you heard about us in *Policies & Procedures Acceptance Signature - I have read and understand the policies and procedures of the Pilates Institute and acknowledge that I must give a 48 hour written notice to cancel a scheduled class. I have undergone a health examination from my medical doctor and have been cleared for exercise of this type. I also understand that, at times, I may have a substitute teacher. I understand this teacher may be a contract instructor and is not employed by the Pilates Institute of Scottsdale. By signing this form using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. *Clear SignatureNextOccupation *Select all that apply to your type of work: *Standing for prolonged periodsSitting for prolonged periodsComputer UseNone/Other - please specify belowOther type of work: *Medical History - Select any of the following that you have: *High Blood PressureHeart ConditionStrokeDiabetesPacemakerSeizuresCancerOsteopeniaOsteoporosisScoliosisKyphosisArthritisOther - please specify belowNone - I do not have any medical conditions.It is important that you keep Pilates Institute of Scottsdale informed of any changes in your medical history. Please report any new conditions or changes in medical condition to us immediately.Other Medical Conditions: *Specify any Food Allergies/Intolerances of any kind: *Type "none" if this does not apply to you.Joint Problems or Past Surgeries *Type "none" if this does not apply to you.Previous Medical Issues *Type "none" if this does not apply to you.Do you take any medications that may directly affect you during your workout? *NoYes - specify below.Specify any medications that may directly affect you during your workout *Name of Doctor *How many days per week do you regularly participate in cardio vascular exercise? *How many minutes per session do you regularly participate in cardio vascular exercise? (copy) *If any, what other non-cardio activities do you participate in? *Type "none" if this does not apply to you.NextRelease of Liability Acceptance Signature - RELEASE OF LIABILITY In consideration of being allowed to participate in any way in the PILATES INSTITUTE OF SCOTTSDALE’S program, related events and activities, the undersigned acknowledges, appreciates and agrees that: 1. The risk of injury from activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the states and customary terms and conditions for participation. If, however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless the PILATES INSTITUTE OF SCOTTSDALE their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (Releasees), with respect to all and any injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law. 5. I understand that there is a 48 hour cancellation policy by written notice. I understand that the package I purchase has expiration dates unless prior notification has been given. 6. I understand that instructor to further the knowledge of specific exercises will use tactile movements. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. By signing this form using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. *Clear SignatureI have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. By signing this form using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.PreviousNextCOVID-19 Waiver Acceptance Signature - I acknowledge the contagious nature of Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing and wearing face coverings. I further acknowledge and agree that Pilates Institute has put in place reasonable preventative measures to reduce the spread of Coronavirus/COVID-19 and other viruses and illnesses. I further acknowledge and agree that Pilates Institute cannot guarantee that I will not become exposed to or infected with Coronavirus/Covid-19 or any other virus or illness while using Pilates Institute facilities or equipment. I understand and agree that the risk of exposure to Coronavirus/COVID-19 and other viruses and illnesses is inherent and unavoidable with regard to the activity of visiting and working out in a gym or similar facility. I understand and agree that this risk may result from the actions, omissions, or negligence of myself and/or others, including, but not limited to, Pilates Institute staff, members, clients, guests, and others using or visiting Pilates Institute facilities. I voluntarily seek services provided by Pilates Institute and acknowledge that by doing so I am increasing my risk of exposure to Coronavirus/COVID-19 and other viruses and illnesses. I acknowledge that I must comply with procedures to reduce the spread or Coronavirus/COVID-19 and other viruses and illnesses at any Pilates Institute facility. • For my protection and the protection of others, in consideration of being granted access to Pilates Institute facilities and equipment, and knowing that Pilates Institute and its staff, members, clients, guests, and others will act in reasonable reliance on the truth of my statements herein, I represent, warrant, and attest that: • I am not experiencing any symptom of illness, including but to limited to cough, shortness of breath or difficulty breathing, fever, chills, shaking, muscle pain, headache, sore throat, or loss of taste or smell. • I have not traveled internationally within the last 14 days. • I have not traveled to a highly impacted area within the United States of America in the last 14 days. • I have not been exposed to anyone with a suspected and/or confirmed case of Coronavirus/COVID-19 or any other contagious disease or illness in the last 14 days. • I have not been diagnosed with Coronavirus/Covid-19 or any other contagious disease or illness (unless I have also been cleared as non-contagious by public health authorities after being so diagnosed). • I have been following and will continue to follow all applicable guidelines relating to the prevention of disease and prevention of the spread of disease issued by the CDC and by the public health departments/officers of the cities, counties and states in which I work, live, and visited within the past 14 days, and in which the Pilates Institute facilities which I use are located. • On behalf of myself, my family members, my heirs, representatives, and successors, I hereby willfully and voluntarily acknowledge and accept the risks of being present at and using Pilates Institute facilities and equipment and being near others using Pilates Institute facilities and equipment, and to the maximum extent permitted by law release and agree to hold Pilates Institute harmless from any and all causes of action, claims, demands, damages, costs, expenses and compensation for injury, illness, damage or loss to myself and/or property that may be caused by any act or failure to act (including ordinary negligence) of Pilates Institutes, or that may otherwise arise in any way in connection with any services received or my presence at any Pilates Institute facility. • I understand that this liability release and waiver supplements and does not replace or reduce any liability release and/or waiver I have previous agreed to, such as in my Pilates Institute membership agreement. [1] All references to ‘Pilates Institute’ herein include all affiliated Pilates Institute facilities and businesses (including Pilates Institute and any future Pilates Institute facility and/or business), as well as their officers, directors, staff, employees, agents, contractors, and servants. By signing this form using any device, means or action, you attest that you have read and you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. *Clear SignatureBy signing this form using any device, means or action, you attest that you have read and you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.Please answer this question to help ensure you're a human and not a spam bot - thank you! *What is 7 plus 3? Enter answer as numbers.WebsiteSubmit