New Participant Form

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Day

Month

Year

Please read the following carefully. If answer Yes to any of the following please check in with a doctor before participating.

Has your doctor ever said you have a heart condition?

Yes

No

Do you have pain in your chest when exercising?

Yes

No

Have you ever lost consciousness?

Yes

No

Do you suffer from high or low blood pressure?

Yes

No

Have you recently had surgery recently?

Yes

No

Do you have a chronic illness that limit physical activity?

Yes

No

Do you have any injuries?

Yes

No

Additional Information

Yes, subscribe me to your newsletter.

Privacy and Data Protection (GDPR) You have the right to access your personal data, request correction or inaccurate information, request deletion of data where appropriate, withdraw consent for processing at any time

I have read and understand Privacy and Data Protection statement

I consent to Reform PYP collecting data and processing my personal and health information for the purposes outline above

On occasion, filming or pictures may be taken during sessions for marketing and promotion. It is entirely voluntary and can withdraw my consent at any time. I understand once shared, Reform PYP may not be able to control further sharing by third parties

I give consent to photos and videos been taken and used for purpose by ReformPYP

I do not give Consent for any photos or videos been taken and used

I confirm that the information provided on this form is accurate and complete to the best of my knowledge. I understand that participation in Pilates and exercise activities carries an element of risk, and I agree to take part at my own risk.

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