Child Registration & Consent Form

This form is to be completed by the legal parent/guardian of any child taking part in Pilates at AM Pilates London aged between 5-18 years old.

PLEASE READ THE FOLLOWING CAREFULLY

• Children’s classes last for 30 or 45 minutes. Please check with Alex what duration she suggests.

• The studio does not accept participants aged under 8 years of age.

• Only the Parent/Guardian or other authorised adult listed on this Consent Form may accompany and/or collect the participant from the studio, unless the parent/guardian/authorised adult has given consent that the child may leave the studio unaccompanied.

• The authorised adult may remain at the studio if that would make the child feel more comfortable.

• If a participant has medical needs which requires prescribed medication, an authorised adult (listed on this form) must remain in attendance at the studio for the duration of the class to administer the medication if required.

• Terms and Conditions apply to children’s classes including the cancellation policy.

Child's Name

First Name

Last Name

Address

Postcode

Date of Birth dd/mm/yyyy

Doctor's Name & Surgery

Doctor's Contact Number

Parent/Guardian Name

Parent/Guardian Contact Number

Parent/Guardian Address if different to above

Parent/Guardian email address

Additional Adult Contact Name

Additional Adult Contact Number

It is assumed that the authorised adults listed above will be primarily responsible for dropping-off and picking-up the participant unless informed to the contrary. Please list details of any other authorised responsible adults, that have the right to drop-off and pick-up the participant, below

Does your child have medical needs (including medicines) and/or allergies? If Yes please provide details.

Yes

What do you hope your child will gain from 1-1 Pilates classes?

Are there any special themes that you feel may capture your child’s interest?

What other sports/physical activity is your child involved in and to what level of intensity?

Please provide details of any health concerns not already mentioned that you would like to make the instructor aware of:

Does your child have permission to leave the studio unaccompanied at the end of the class?

Yes

From time to time AM Pilates London would like to send you emails including offers, news, class timetable updates. Please select below whether you would like to receive these.

Yes

I give consent for my child to participate in Pilates Classes at AM Pilates London. I give consent to contact emergency assistance, if required, in the event of an injury. By inputting my name below I confirm that I have read and understood this Parent/Guardian Consent Form and AM Pilates London Terms and Conditions. I realise that by participating in a Pilates class my child may be at risk of injury and I hereby confirm that they are participating voluntarily.

I confirm

Parent/Guardian Name

Date dd/mm/yyyy

Terms & Conditions