Health Form | Head to Toe Harmony

Request a Quote

Particpant Health Disclaimer Form / Par Q

This form is for people who are participating in Pilates sessions, whether in a group, in person or via video format. This form will cover you for all future classes, but you must complete it again and resubmit should there by any updates or changes to your health. Data protection is in place and none of your details will be provided to other third parties. This is a protected disclaimer and health information gathering form only.

Please take a moment to fill out the form.

First Name

Last Name

Date of Birth

Contact number

Company Name (if applicable)

In the event of an emergency, what is the name if your emergency contact?

Emergency contact tel number:

If you have answered yes to any of these questions, please provide more details, including medication, here:

I, the client, hereby sign this form (by way of electronic submission) to confirm that I provide full consent to participate in any exercise sessions bookings from here (with Head to Toe Harmony) on and that, by doing so, I accept physical and health risks. I know I am responsible for contacting my GP or medical consultant should I be unsure if I can participate in this/these session/s. I will ensure I advise the instructor of any changes to my health or other details that I submitted on this on this form.

Electronic Signature. By typing your name this is or signature of consent.

Select a date

Thanks for submitting!