Pre-Order Viola Pilates TOTE, Your Gym In a BAG

1-403-617-8608

323 10 Ave SW, Unit #407, Calgary, Alberta, CANADA T2R 0A5

Viola Pilates Release Form & Waiver

At Viola Pilates, we take supporting your health seriously ~

If you've like to take classes, please print & sign the following Release Form & Waiver & send back to Viola Pilates at violadesigns@hotmail.com prior to taking any classes. 

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Disclosure, Release and Assumption of Risk

In consideration of being allowed to participate in Pilates lessons, classes, and workshops presented by Viola Pilates by Design (collectively, the “Pilates Program”), and to use the associated Pilates equipment, I agree to the following:

  1. It is my responsibility to consult with a physician prior to and concerning my participation in the Pilates Program.

  2. I warrant that to the best of my knowledge I am physically fit and have no psychological, medical, or emotional conditions that would prevent me from participating comfortably and safely in the Pilates Program.

  3. I represent and warrant that the information concerning my physical and medical condition set forth in the attached Appendix A is accurate and correct.

  4. I acknowledge an undertaking from Pilates by Design that they will treat as confidential and will not share any information they obtain from me or others about my physical and medical condition and my physical fitness.

  5. I acknowledge that during the course of a Pilates Program the instructor may provide physical adjustments or instructions and that it is my responsibility to inform the instructor if I do not want these adjustments and corrections.

  6. I acknowledge that if I cancel a booked Pilates lesson, class, or workshop less than 24 hours from the appointed time, I am responsible to pay for same nevertheless unless expressly waived by Viola Pilates by Design.

  7. I acknowledge that Viola Pilates by Design will undertake to take all reasonable steps to ensure that the exercises, procedures and routines prescribed or performed by me in the Pilates Program will be appropriate for my needs and will be safe taking into account my physical condition and limitations. However, I assume full responsibility for any injuries I may sustain by participating in the Pilates Program and waive and release Viola Pilates by Design from responsibility or liability for any such injuries.

  8. I acknowledge that while Pilates by Design undertakes to sterilize the Pilates studio and equipment before my lesson, class, or workshop, if I become infected with Covid-19 by reason of participating in the Pilates Program, I will not hold Viola Pilates by Design liable for same.

    ________________________ Sign & Print Name:

    Date:

Appendix A: Physical condition and medical disclosure

  1. Do you have, or have you had, an injury, back or joint condition that may be affected by an exercise program?

  2. Are you currently experiencing any pain in your body?

  3. Have you ever had asthma, epilepsy, or suffer from dizziness?

  4. Are you now or have you recently been pregnant? (Please advise your instructor if you should become pregnant)

  5. Do you currently have any illness or infection?

  6. Have you recently undergone surgery?

  7. Are you currently receiving physiotherapy or chiropractor massage?

I have not withheld any information that may affect my ability to perform the exercises in the Pilates Program. Should my personal circumstances change, e.g. sustain an injury, I will inform my instructor.

___________________________ Sign & Print Name:

Date: