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Children Registration formJohn Isaacson2024-10-01T13:48:01+01:00

Registration form for Children

"*" indicates required fields

Consent*

I confirm that I am the legal guardian/parent of the client mentioned below

I consent for the client mentioned below to participate in Clinical Equipment Pilates at Complete Pilates

I understand that the below client is U16 and it is my responsibility to pay in advance for the said client

I confirm that the below-mentioned client is aged between 13-16 years and give my consent for them to attend sessions on their own without a legal guardian/parent present.*

Yes

I confirm that the client mentioned below is under the age of 13, and a legal guardian or parent will attend the entire session.*

Yes

General information

Name*

First Last

Date of birth*

MM slash DD slash YYYY

Sex*

Male

Female

Other

Contact telephone number for legal guardian / parent*

Contact email for legal guardian / parent*

Medical information

Is the client currently seeking medical attention for any injury, illness or pain?*

Yes

If yes please give details below*

Please give details below of current activity levels of the client*

Please tick if the client has any of the following medical conditions*

No medical concerns

Diabetes

Asthma

Epilepsy

Heart conditions

Lung disease

Osgood-Schlatters Disease

Diagnosed spine conditions

Sever’s disease

Any other

Diagnosed spine conditions - If yes please give details*

Any other (please give details)*

Please accept the below policies*

I have read the terms and conditions

I understand the cancellation policy

I understand the privacy Policy

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Comments

This field is for validation purposes and should be left unchanged.

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New clients registration Antenatal registration Postnatal registration Children’s registration Outcome measures Oncology rehabilitation registration Clinical Pilates Referral form Hand Held Dynamometry

0203 764 5668

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Business Design Centre
52 Upper Street
Angel
London
N1 0QH

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Lower Ground floor
37-39 Lime Street
London
EC3M 7AY

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Chelsea Clinic
First Floor
321 Fulham Road
London
SW10 9QL

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© Copyright 2012 - | Designed and Maintained by WPMaintain | All Rights Reserved
Complete Pilates Medical Ltd registered in England & Wales at 115 Hampstead Road, London, NW1 3EE (for correspondence only), company number: 10206019.
Complete Physio Ltd registered in England & Wales. 18 Church Hill, Winchmore Hill, London, N21 2JB (for correspondence only), company number: 05926168

Registration form for Children

General information

Medical information

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