Physiotherapy Posture & Pilates

Pilates Enrolment Casual Term 3 2018

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Client 1

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Client Details

Client First Name

Client Last Name

Date of Birth

Gender

Male Female

Email Address

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Home Phone

Mobile/Cell

Parent/Guardian Details

Mother's Name

Mother's Email Address

Mother's Mobile/Cell

Father's Name

Father's Email Address

Father's Mobile/Cell

Address

Address 1

Address 2

Suburb/Town

State/Prov

Zip/Postcode

Health and Fitness

Do you have any injury concerns?

Do you have any medical conditions?

Sport (if applicable)

Training Dates

From 16-Jul-2018 to 21-Sep-2018

Training Days & Times

Once a time slot is full you will be asked to make another choice.

Time	Mon	Tue	Thu	Fri
9:30 - 10:30 am		Clinical Pilates Equipment Class (Therese) Call or email for date reservation $32/class FULL		Clinical Pilates Equipment Class (Carolyn) Call or email for date reservation $32/class
11:00 - 12:00 pm			Clinical Pilates Floor Class Call or email for date reservation $32/class
1:30 - 2:30 pm		Clinical Pilates Equipment Class (Therese) Call or email for date reservation $32/class	Clinical Pilates Equipment Class (Therese) Call or email for date reservation $32/class FULL
4:15 - 5:15 pm		Clinical Pilates Equipment Class (Therese) Call or email for date reservation $32/class FULL
5:30 - 6:30 pm	Gymstick Muscle Call or email for date reservation $32/class	Clinical Pilates Equipment Class (Therese) Call or email for date reservation $32/class	Clinical Pilates Equipment Class (Carolyn) Call or email for date reservation $32/class

DISCLAIMER:
Clients enrolling in Term classes will have preference over time slots but where there is space, it will be first come, first served basis. Options for attending busy time slots will be given if there are cancellations. Please call 97253175 or email [email protected] to schedule the days and times you want to attend. Choose the time slot you are most likely to attend on this enrolment form. It is important that you cancel your time slot if you are unable to attend ideally within 24 hours so others have the option to use this space. Repeat late cancellations may result in a time slot not being reserved in the future especially in popular times.

Agreement

I agree

Signed (Parent/Guardian)

Date

25-Apr-2024

Payment Method

Clients enrolling in Term classes will have preference over time slots but where there is space, it will be first come, first served basis. Options for attending busy time slots will be given if there are cancellations. Please call 97253175 or email [email protected] to schedule the days and times you want to attend. Choose the time slot you are most likely to attend on this enrolment form. It is important that you cancel your time slot if you are unable to attend ideally within 24 hours so others have the option to use this space. Repeat late cancellations may result in a time slot not being reserved in the future especially in popular times.

Cost

$32.00 Casual Rate per session (per session)

Cost Per Person

$0.00

Total Cost

$0.00

Group Discount

Promo Code

Promo Code Discount

Grand Total

Bank Transfer

Bank details will be provided on the next screen

Cash

Payment must be made by Week 1

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