Physiotherapy Posture & Pilates

Physio Equipment Class Enrolment Form Term 4 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

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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 12-Oct-2020 to 18-Dec-2020

Training Days & Times

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

Time	Mon	Tue	Wed	Thu	Fri
9:00 - 10:00 am	Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton				Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
9:30 - 10:30 am		Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton		Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
10:15 - 11:15 am	Physio Equipment Class (David) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL		Physio Equipment Class (David) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton		Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
1:30 - 2:30 pm		Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton		Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL	Physio Equipment Class (David) Dependent on numbers Physiotherapy Posture & Pilates 48 Eaton Drive Eaton
4:15 - 5:15 pm	Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL	Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL	Physio Equipment Class (David) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL
5:30 - 6:30 pm	Physio Equipment Class (David) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton	Physio Equipment Class (Therese) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL		Physio Equipment Class (Carolyn) Physiotherapy Posture & Pilates 48 Eaton Drive Eaton FULL

DISCLAIMER:
I understand and have read the class policy and acknowledge my responsibility if I cannot make a class that I must alert reception in the agreed time if I am to be offered a make up class option.

Agreement

I agree

Signed (Parent/Guardian)

Date

24-Apr-2024

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)
$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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