Physiotherapy Posture & Pilates

Physio Equipment Class Enrolment Form Term 1 2020 (10 Weeks)

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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

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)

Dates

From 03-Feb-2020 to 09-Apr-2020

Days & Times

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

Time	Mon	Tue	Thu	Fri
9:00 am	Physio Equipment Class (Carolyn) 9 weeks as Public Holiday Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL			Physio Equipment Class (Carolyn) 9 weeks as Public Holiday Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
9:30 am		Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL	Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
10:15 am	Physio Equipment Class (Carolyn) 9 weeks as Public Holiday Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL			Physio Equipment Class (Carolyn) 9 weeks as Public Holiday Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
1:30 pm		Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
4:15 pm		Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL	Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
5:30 pm	Physio Equipment Class (Therese) 9 weeks as Public holiday 2/3/20 Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton

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

Date

24-Jan-2020

Payment Method

There are no refunds for any enrolments into Physiotherapy Posture & Pilates related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.

Cost

$300.00 10 week term fee 1 class per week paid by Week 1
$500.00 10 week term fee 2 classes per week paid by Week 1
$250.00 10 week term fee for one when 2 or more Family members enrol in class paid by Week 1
$32.00 Casual rate per session (Confirm dates with reception) (per session)
$270.00 Monday/Friday Participants for 9 weeks due to Public Holidays
$475.00 Monday/Friday Participants twice a week allowing for Public Holidays
$450.00 Monday/Friday Participants twice a week with a Mon/Fri second session allowing for Public Holidays
$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

Term Fee enrollees payment must be made by Week 1

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