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The following conditions could affect your ability to exercise and perform certain movement.
Please check and specify which apply to you.
Are you under a doctor’s care for any specific chronic illness, pain or injury? If so please specify:
Do you periodically or chronically have pain in any of the following areas (please check all that apply to you)?:
Please explain any other medical/physical circumstances or accidents you have had that could impact your participation in an exercise program:
ACTIVITY PROFILE: Please indicate any exercise you participate in on a regular basis:
GOALS: Please indicate below 3 –4of your current fitness goals (i.e. flexibility, strength, weight etc.)
Please briefly state your expectations from participating in a Pilates, Gyrotonic, and fitness program:
To the best of my knowledge, all of the above statements are complete and accurate.
Parent/Legal Guardian Signature:
PURE MOVEMENT PILATES STUDIO
TERMS OF SERVICE & PARTICIPANT AGREEMENT
This Terms of Service & Participant Agreement (“Agreement”) is made by and between the undersigned Participant and Pure Movement Pilates Studio (“PMPS”), located at 526 W. Jefferson Boulevard, Fort Wayne, Indiana, and entered into on the day, month, and year as stated below. This Agreement shall be governed by Indiana law, and any claim or dispute arising thereunder shall be adjudicated in the court having proper subject matter jurisdiction and venue in that state. In the event that any provision or part thereof within this contract is deemed unenforceable in law or contrary to public policy, the remainder shall continue to govern the Parties and be given full force and effect. Participant acknowledges that without assent to the provisions herein contained, client and wellness services offered at PMPS would not be made available for his or her use and enjoyment.
ART. I: INFORMED CONSENT & WAIVER OF LIABILITY.
Participant has enrolled in a program of instruction or participation in Pilates, GYROTONIC®, GYROKINESIS®, massage and any other program of instruction or service offered by PMPS; Participant desires to undertake PMPS' program of instruction or service with the full knowledge of the possibility that physical injuries could result from the program of instruction and desires to assume the risk of any such injury; and the Parties recognize that PMPS would not be able to and will not provide its program of instruction to participant without the execution of this agreement. Participant understands that the instruction involves a certain amount of physical contact and tactile instruction/service and that it is the responsibility of Participant to tell the instructor if at any time they feel the tactile instruction or service is inappropriate or uncomfortable.
THEREFORE, in consideration of the above and of the program on instruction to be provided, and for use of PMPS facilities and equipment, Participant hereby acknowledges, assents, and agrees to the following:
- Participant releases, discharges, absolves, and holds harmless PMPS, its directors, members, shareholders, employees, apprentices, student teachers, and contractors from any and all claims, demands, rights of action, or causes of action present or future, whether known or unknown, resulting from Participant's participation in this program of instruction or service or use of PMPS’ facilities or equipment that may be made by Participant, or by Participant's family, estate, heirs, or assigns. Participant expressly assumes the risks of all accidents or injuries of any kind of which Participant may sustain by reason of, or in connection with, the program of instruction or use of PM's facilities or equipment.
- Participant acknowledges that PMPS makes no claims as to medical results which can or may be obtained through participation in this program of instruction or service or use of PMPS facilities and/or equipment. PMPS has neither suggested nor will suggest any medical treatment to Participants. Only licensed professionals are qualified to render medical advice. Participant is instructed not to act on the medical advice given by any unlicensed employee, agent, or contractor of PMPS until and unless such advice has been verified with a licensed professional or their own physician.
- Participant been advised and understands that a medical evaluation is advisable before commencing any program of physical conditioning or exercise. Participant represents that there is no medical or physical condition which would prevent them from participating in the program of instruction or form using PMPS’ equipment or facilities. Participant further represents that she/he has not been instructed by any physician not to do so, and will continue to keep PMPS fully informed of any medical condition or disability which would prevent or limit Participant's participation in the program of instruction or use of facilities and/or equipment. PMPS shall keep all such medical and personal information confidential. Participant also understands that she/he should stop exercising immediately if Participant detects pain, dizziness or discomfort of any sort during the course of the exercise session.
- Participant understands that a surety bond does not secure the prepayment of services, and that they may run the risk of loss of prepayment in the event of closure, bankruptcy or loss of instructor. Participant understands and agrees that if he/she purchases a series of sessions it is his/her responsibility to fully utilize the sessions within the validity time established by PMPS. It is not the policy of PMPS to refund any balance of unused sessions.
Participant understand and agrees to the conditions stated above and is freely signing this Agreement.
ART. II: TWENTY-FOUR (24) HOUR CANCELLATION POLICY.
Because scheduling a class holds and reserves use of studio space and equipment, and thereby prevents other patrons from scheduling for the same period, and in light of PMPS’ instructors’ limited availability, late cancellations impose tremendous strain to the studio operation. Pure Movement Pilates Studio kindly requests at least Twenty-Four (24) hours advanced notice of cancellation of any previously scheduled class. PMPS recognizes emergency situations may arise making cancellation within this period impossible. In such extraordinary circumstances and/or events, PMPS will seek to accommodate Participant to reschedule his or her session at the earliest possible opportunity. By signing below, Participant hereby authorizes Pure Movement Pilates Studio, solely at its discretion, to charge the full amount of a late cancelled scheduled class or a nonappearance using Participant’s credit card on file or against a purchased session credit remaining in his or her PMPS studio account, as though Participant had in fact attended the scheduled session.
ART. III: WAITLIST POLICY.
Participant may seek to be added to a fully registered regularly scheduled class from the “Waitlist.” In such case, Participant agrees to be bound by the following Waitlist policies:
- In the event Participant is added any class from the Waitlist more than Twenty-Four (24) hours in advance of its occurrence, Participant will receive an email notification of such fact. If, thereafter, Participant fails to attend the class, Participant agrees to permit PMPS to charge the full amount for the nonappearance using Participant’s credit card on file or against a purchased session credit remaining in his or her PMPS studio account, as though Participant had in fact attended the scheduled session;
- In the event Participant is added any class from the Waitlist less than Twenty-Four (24) hours in advance of its occurrence, Participant may receive a message direct from an instructor or PMPS representative of such fact. Participant should then seek to confirm with PMPS whether or not he or she plans to attend. However, in the event Participant does not respond, or is unable to attend due to short notice, Participant will not be charged for his or her nonappearance.
ART. IV: LATE ARRIVAL POLICY.
During the first Ten (10) minutes of every scheduled session, instructors undertake a warmup routine designed to mitigate any risk of physical injury occurring as a result of the class. To promote the safety and well-being of Participant, and for the consideration of all other PMPS clients and staff, Participant agrees to arrive no more than Ten (10) minutes after any scheduled class start time. If Participant should arrive more than Ten (10) minutes following the regularly scheduled commencement he or she will not be permitted to enter the studio space, regardless of the particular circumstances. In addition, Participant agrees that, at PMPS’ sole discretion, PMPS may treat Participant’s late arrival as a late cancellation pursuant to the 24-Hour Cancellation Policy procedures of Article II, and may be assessed full cost for the class thereby.
ART. V: PHOTO RELEASE.
For valuable consideration received, Participant hereby grants Pure Movement Pilates Studio, its agents, and assigns the irrevocable and unrestricted right to take, use, and publish photographs of him or her, or in which he or she may be included, for editorial, trade, advertising, and any other purpose and in any manner and medium; Pure Movement Pilates Studio is further authorized to alter and composite same without restriction and without Participant’s prior inspection or approval being required. The undersigned Participant hereby releases Pure Movement Pilates Studio, its agents, and assigns from all claims and liability relating to use of said photographs.
ART. IV: PACKAGE EXPIRATION.
Private, semi-private, and group drop-in packages have an expiration of Six (6) months. Monthly memberships have an expiration of 45 days, auto-renewing every Thirty (30) days.
ART. VI: REFUNDS.
It is not the policy of Pure Movement to refund any balance of unused sessions, classes, or packages. Packages may be transferred to another student at Pure Movement, as long as the packages are valid under the expiration date.
ART. VII: SCHEDULING AND PAYMENT.
All private and semi-private sessions are by appointment only and scheduled through your instructor. Group classes are scheduled through our website, puremovementstudio.com/classes, or via our applications, MindBody Connect or PM Pilates. Participant may be required to place a credit card on file to reserve an appointment. All sessions, group or private, must be prepaid in advance. If Participant attends a class without a sufficient account credit, Participant hereby authorizes Pure Movement Studio to charge his or her credit card on file to the extent of the cost of the session. If Participant remits payment by check or credit/debit card, and such check or a credit/debit card should be returned and/or has an insufficient balance, a Thirty-Five Dollar ($35.00) NSF transaction fee will be assessed for which Participant shall be solely responsible. Sessions are Fifty (50) to Fifty-Five (55) minutes in length, and if a student is late, time will not be correctively added.
ART. VIII. STUDIO ATMOSPHERE & CONDUCT.
For the respect of other clients of Pure Movement Pilates Studio, and to maintain a positive wellness environment, Participant covenants and agrees to:
- Keep voices lowered in or out of a session;
- Remove shoes by the benches before entering the floor of the studio;
- Refrain from wearing strong scents or perfumes, as some have reactions to strong scents;
- Enter quietly when arriving late for a group session;
- Not chew gum during session;
- Silence cell phones and other data devices;
- Clean used mats and equipment after the completion of a group class;
- Abstain from wearing regular socks during sessions due to considerations of personal safety; Participant must be barefoot or otherwise using ToeSox (available at Idlehour Boutique) or comparable sticky grip socks.
By signing below, undersigned Participant hereby acknowledges, that he or she is at least 18 years of age, that Participant is of sound mind, and is presently not under the influence of any psychotropic drug or alcohol, that this instrument represents the complete and final agreement of the parties thereto, and that Participant has thoroughly reviewed, understands, assents, and consents as to all foregoing conditions, provisions, and terms of service relating to Pure Movement Pilates Studio wellness services.
In such case that Participant is a minor or an incapacitated person unable to validly contract in accordance with Indiana law, I, the undersigned below, hereby affirm that I am the parent, legal guardian, or custodian of the Participant identified above, and I sign in his or her stead. For valuable consideration received, I hereby covenant and agree to fully indemnify and hold financially harmless Pure Movement Studio, as well as its directors, members, shareholders, employees, apprentices, student teachers, and contractors, for any and all damages in relation to or arising from any and all claims, demands, rights of action, or causes of action, present or future, whether known or unknown, resulting from participation in wellness services at Pure Movement Studio by the minor or incapacitated person under my legal care and supervision. To the extent allowed by law, I additionally assent to all terms, conditions, and provisions above, including those contained in Art. I herein, as though I were Participant.
Parent/Legal Guardian Signature Below: