CBPilates PAR-Q New Student Form

Catheryn Burdett, Member Pilates Foundation, Society for the Pilates Method Teacher Register

Mark Burdett, Certified BASI PILATES (Body Arts & Sciences International) www.basipilates.com

Please fill out the following form. Fields marked with an asterisk are compulsory fields.

First name

Last name

Address

Phone. Enter your country code +44 before your phone number.

Date of birth

Month

Day

Year

Pilates cannot substitute for medical advice or treatment.

The following questions will help us be aware of your exercise needs. Please answer each question to the best of your ability. If a question doesn’t apply to you, insert ‘N/A’.

Have you ever done Pilates before, or are you currently doing Pilates Matwork or apparatus (Reformer, Tower, etc.) in another setting? If so, please let us know more about the level and type of class.

What are your reasons for taking up Pilates?

Are you participating in any other exercise/sport (e.g. yoga, barre, weight training, cardio, running, golf, tennis, etc.) If so, how often?

Hands-on Cueing: Pilates teachers may sometimes employ hands on assistance with exercises to help alignment or form. Do you consent to, and are you comfortable with, tactile cueing? (If not, this can be avoided).

Yes

Does your work require you to sit for long hours, or is your work physically demanding?

Yes

Does your work require you to sit for long hours, or is your work physically demanding?

CB Pilates

Core Integration
Flexibility Strength Stamina
Matwork | Reformer | Apparatus

CBPilates PAR-Q New Student Form

Pilates cannot substitute for medical advice or treatment.