Physiotherapy Posture & Pilates

Pilates Enrolment Form Term 4 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

Confirm Email Address

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Enter the password that you would like to use for your new account.

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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 08-Oct-2018 to 21-Dec-2018

Training Days & Times

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

DISCLAIMER:
I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Physiotherapy Posture & Pilates coaches. I understand that similar to all sporting activities, there is a risk of damage to personal property, injury or death which may result from causes beyond the control of, and without fault or negligence of Physiotherapy Posture & Pilates, its officers, agents, or employees, during the period of my (or my child's) participation. I understand completely the above agreement and agree to be bound thereby. By registering on our site you agree that we may send you email related to our facilities and programs. We will not provide your details to any other company.

Agreement

I agree

Signed (Parent/Guardian)

Date

20-Apr-2024

Payment Method

****IMPORTANT PLEASE READ: The CONFIRMATION EMAIL you will be sent has default setting for FULL AMOUNT payable if you are paying for a term. You are only required to pay HALF OF THE TOTAL for the first 5 weeks and have the option of using your private health fund card to claim for the first half of term which will be taken off the balance owing for the second half of term. You can still pay half the term fee upfront even if you are not claiming for the first half of term*****

Cost

$330.00 11 week term 1 class per week Term Fee(option of $150 payable upfront for first 5 weeks )
$550.00 11 week term 2 classes per week Class Discount Rate (option of $250 payable upfront for first 5 weeks)
$275.00 11 week term fee for one when 2 or more Family members enrol in class (option of $125 payable upfront for first 5 weeks)
$32.00 Casual rate per session (Confirm dates with reception) (per session)
$300.00 Finishing early. 10 week 1 class per week Term Fee (option of $150 payable upfront)
$0.00 Other option. Discuss with reception staff for pricing options

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

50% of the Term Fee you are enrolling in must be made by Week 1

Enter security code

Time	Mon	Tue	Thu	Fri
9:00 - 10:00 am	Clinical Pilates Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton			Clinical Pilates Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
9:30 - 10:30 am		Clinical Pilates Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Clinical Pilates Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
10:15 - 11:15 am	Clinical Pilates Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton			Clinical Pilates Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
1:30 - 2:30 pm		Clinical Pilates Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Clinical Pilates Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
4:15 - 5:15 pm		Clinical Pilates Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Clinical Pilates Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
5:30 - 6:30 pm	Gymstick Muscle (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Clinical Pilates Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Clinical Pilates Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton