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Health Assessment Form/Wavier
First Name
Last Name
Email
Date of Birth
Have you had any major medical procedures, given birth or on any medication in the last 12 months
No
Yes
Please specify, as this is important for your pilates session
Initials
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
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