New Customer Form

Statement of Understanding: I understand and agree that as a student here I will be challenging myself mentally and physically and trust the instructors to guide me in the best way possible for my development. I enter the studio and use the equipment voluntarily and at my own risk.

Name*

Date of Birth*

Email*

Phone

Emergency Contact (Name & Phone Number)*

Please list any injuries you've sustained. *

Please list any medications you are currently taking.*

Please list any surgeries you have undergone*

What are your prior movement and exercise experiences?*

What goals do you hope to achieve through Pilates?*

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Statement of Understanding

I understand and agree that as a student here I will be challenging myself mentally and physically and trust the instructors to guide me in the best way possible for my development. I enter the studio and use the equipment voluntarily and at my own risk.

Balance & Flow Pilates

2 Frog Hollow Alley, Middlebury, VT, USA

607.968.1444 Susan@balanceandflowvt.com

New Customer Form

Statement of Understanding: I understand and agree that as a student here I will be challenging myself mentally and physically and trust the instructors to guide me in the best way possible for my development. I enter the studio and use the equipment voluntarily and at my own risk.

Statement of Understanding

Balance & Flow Pilates

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