Lulu Chavez | Home Studio

Thank you for choosing to participate in wellness services with Lulu Chavez. 
Please complete this form prior to your session so your experience can be safe, personalized, and enjoyable.

 
 

Pilates Reformer Intake Form & Liability Waiver

Pilates Reformer Participation

I understand that Pilates Reformer involves physical activity including stretching, strengthening, balance, coordination and the use of Pilates equipment.
I agree to work within my abilities, follow instructor guidance, and immediately communicate any pain, dizziness or unusual discomfort.
I understand that participation is voluntary and physical activity carries inherent risks, including soreness, strains, falls or injury.

Bodywork & Pilates

For safety, massage, chiropractic treatment, acupuncture and myofascial bodywork should not be scheduled before Pilates on the same day.

If both are scheduled on the same day, complete Pilates first and bodywork afterward. If bodywork is scheduled before Pilates, reschedule your Pilates session.

Follow any exercise restrictions provided by your healthcare provider.

Essential Oils & Sound

Pilates sessions may occasionally include essential oils, crystal singing bowls or other sound instruments.
Inform Lulu Studio in advance of any allergies, sensitivities or concerns related to fragrance, essential oils, sound or vibration.
Participation in these elements is optional and they are not intended to diagnose, treat, cure or prevent any medical condition.

Assumption of Risk & Release of Liability

I voluntarily participate in Pilates Reformer and movement sessions at Lulu Studio and understand that physical activity and Pilates equipment involve inherent risks.
To the extent permitted by law, I release and hold harmless Lulu Chavez and Lulu Studio from claims arising from my voluntary participation, except to the extent caused by gross negligence or willful misconduct.

Acknowledgment

I acknowledge that I have read and understand this intake, informed consent, assumption of risk and liability waiver. I confirm that the information I provided is accurate to the best of my knowledge.

DOB/Fecha de Nacimiento*
Emergency Contact Name & Phone:*
Health History (List all injuries or pain/issue areas) *
Are you taking any medications that may affect your ability to safely participate in exercise?*
Photo/Media Consent *
Pregnancy*
Pacemaker*
Epilepsy*
Allegies*
Sensitive to essential oils*