Client Intake & Health Waiver

Welcome to Selformer. Please complete this form before your first session so we can keep you safe and tailor your Pilates experience. All information is kept confidential.

First name

Last name

Email

Phone

Health & Medical Information

Do you have any physical injuries or health concerns we should know about?

Yes

No

Please list all of your medical conditions & preferences

Are You Currently Pregnant? (Beyond 20 weeks, working out at our studio requires a doctor's clearance, please inform the receptionist)

No

Yes

Yes, beyond 20 weeks

Have you been told by a doctor that you should not exercise, or do you have a heart condition, high or low blood pressure, or any other condition that could be affected by exercise?

Yes

No

I confirm that, to the best of my knowledge, I am medically fit to take part in Pilates and exercise, and I will inform Selformer if my health changes.

Assumption of Risk & Release of Liability

Pilates and physical exercise involve inherent risks, including muscle strains, sprains and, in rare cases, more serious injury. I understand that I take part voluntarily, that I am responsible for exercising within my own limits, and that I will stop and notify an instructor if I feel pain, dizziness or discomfort.

I understand and accept the risks of participating in Pilates and exercise at Selformer.

To the fullest extent permitted by law, I release and hold harmless Selformer, its owners, instructors and staff from any liability, claims or demands for injury, loss or damage arising from my participation, except where caused by gross negligence or wilful misconduct. I confirm that the information I have provided is accurate and complete.

I have read and agree to the release of liability above.

Red Light Therapy Consent

Selformer offers red light therapy (photobiomodulation) using low-level red and near-infrared light. Any benefits are not guaranteed and results vary between individuals. Red light therapy may not be suitable if you are pregnant, have epilepsy or light sensitivity, take photosensitising medication, have an active cancer or malignancy, a thyroid condition, or a light-sensitive skin condition. Protective eyewear must be worn at all times, and this service is not a substitute for medical advice or treatment. Please consult your physician if you are unsure whether it is right for you.

Do any of the following apply to you: pregnancy, epilepsy or light sensitivity, photosensitising medication, active cancer, thyroid condition, or a light-sensitive skin condition?

No

Yes

Unsure

I have read the red light therapy information above, I understand the risks and that results are not guaranteed, I confirm I have no undisclosed contraindications, and I consent to receiving red light therapy at Selformer.

Filming, Photography & Media

From time to time Selformer may photograph or film classes, sessions and the studio for marketing, social media and promotional purposes, and you may appear incidentally in this content. No personal, brand or commercial photography or filming by clients is permitted anywhere in the studio without prior written consent.

I understand that personal, brand or commercial photography and filming by clients is not permitted anywhere in the studio without Selformer's prior written consent.

I consent to Selformer using photographs and video in which I may appear for marketing and promotional purposes. (If you do not consent, please leave this unchecked and let reception know.)

Security & Privacy

For the safety and security of our clients and staff, Selformer uses CCTV security cameras to monitor entrances and communal studio areas. Cameras are never placed in changing rooms, bathrooms or private therapy rooms. Footage is stored securely, used only for safety, security and incident-handling purposes, and retained in line with our privacy policy.

I understand that CCTV security cameras operate in the communal areas of the studio for safety and security purposes.

Studio Policies

Please arrive 5–10 minutes before your session. Grip socks are required in all classes for hygiene and safety. Cancellations or reschedules require at least 12 hours' notice, or the session may be charged. Late arrivals may not be admitted once a class has begun. Please silence mobile phones, keep the studio clean, and do not attend if you are unwell or have a contagious condition. Personal belongings remain your responsibility at all times.

I have read and agree to Selformer's studio policies, including the cancellation, late-arrival, grip-sock and hygiene requirements.

I acknowledge that Selformer’s Private Rooms are intended exclusively for use with Selformer-provided video instruction, and I agree to use them accordingly.

How did you hear about us?

Agreement

I agree to the terms & conditions listed on the Selformer Website

By signing this document, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.

Signature

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