Intake Form

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Pilates Chair Workshop — Registration & Safety Screening

Pilates Chair Workshop Registration

Auckland, New Zealand • Physical Readiness Screening & Consent

1. Attendee Information

2. Emergency Contact

3. Physical Activity Readiness (PAR-Q)

Health & Safety Question Selection
1. Acute or chronic musculoskeletal injuries (disc, rotator cuff, joints)?
2. Any surgical procedures within the past 12 months?
3. Heart conditions, blood pressure anomalies, or dizziness / balance issues?
4. Currently pregnant or postpartum (< 6 months)?
5. Taking medication that affects balance, motor control, or alertness?

4. Participation Terms & Health Declaration

Physical Readiness & Disclosure: I confirm that I am voluntarily participating in physical movement, exercise sequences, and apparatus instruction involving the Pilates Chair. I confirm that I have disclosed all relevant pre-existing injuries, medical conditions, musculoskeletal impairments, recent surgeries, or pregnancy. If I have any doubt regarding my physical capacity, I have obtained prior medical clearance from a qualified healthcare practitioner.

Apparatus & Movement Awareness: I understand that exercising on elevated Pilates apparatus involves inherent physical exertion, dynamic balance, and spring-loaded resistance. I agree to listen carefully to all safety instructions, verbal cues, and equipment setup demonstrations provided by the instructors.

Self-Regulation & Modifications: I take full responsibility for monitoring my own physical limits during every session. I will immediately cease any exercise that causes acute pain, dizziness, or distress, and I will request appropriate modifications or hands-on spotting from the instructor when needed.

New Zealand ACC & Liability Acknowledgment: I acknowledge that personal physical injury in New Zealand is managed under the Accident Compensation Act 2001 (ACC no-fault scheme). To the extent permitted by New Zealand law, I release and hold harmless the event organizers, venue hosts, guest presenters, and event staff from any non-compensatory claims, losses, or property damage resulting from my voluntary participation.