Prenatal Pilates Liability Waiver Form
Please complete this form to participate in prenatal Pilates classes. Read and acknowledge the waiver below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How many weeks pregnant are you?
*
Have you received clearance from your healthcare provider to participate in prenatal Pilates?
*
Yes
No
Do you have any current pregnancy-related complications or concerns?
*
No, I have no complications or concerns
Yes, I have minor concerns (please specify below)
If you answered 'Yes' above, please provide details.
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Participant Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Waiver
Submit Waiver
Should be Empty: