Client Intake Form

Waiver of Liability, and Informed Consent
Please read and initial each statement below to indicate your understanding and agreement, then sign and date at bottom of page.

1. The risk of injury from activities in this program is significant, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; including the potential for permanent paralysis and death.
2. I am aware that it is my responsibility to inform my instructor of any pre-existing conditions before participating in any Peach Pilates Studio activities. I further understand that they hold no liability regarding such pre-existing conditions.
3. I agree to inform my instructor of any new injuries or conditions (including pregnancy) and I agree I am freely participating in Peach Pilates activities with these known conditions. I assume full responsibility and I assume all risk and understand it is my responsibility to consult a doctor about participating in these activities.
4. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and assume full responsibility for my participation.
5. I agree to comply with Peach Pilates conditions of participation, and abide by their policies, including health and safety policies. While participating in these activities, I agree to report any hazard, safety issue, and will act to avoid injuring myself, or others, in case said hazard occurs.
Studio Policies
1. I understand there is a 24-hour cancellation policy for private sessions, duets and Reformer classes, and that I will be charged in full if I fail to provide appropriate notice.
2. I understand that if I reserve space in a class and do not show, I will be charged a $12 drop fee.
3. I understand that all session and class packages expire one year from the purchase date.
4. I understand that there are no refunds, only exchanges and studio credit.
I have read this release of liability and assumption of risk agreement and understand that I
assume all risk for undertaking Peach Pilates activities. I understand I have given up substantial rights by signing and agreeing to these terms. I attest that I am signing this agreement freely and
voluntarily, without any inducement.