Pilates Reformer New Client Consultation/Package Form

1. Select Option

Welcome to the Sharron Baucom Dale City Recreation Center! We are so happy that you have chosen to spend your exercise time with us! We are here to serve and help make your experience not only beneficial but fun as well!

This appointment will be a great way for you to get started on your Pilates journey! During this month, we will demonstrate proper use of the Pilates equipment and assess your fitness level to prepare you to integrate into a group class. All customers are advised that prior to the start of any exercise program they should consult with a physician.

After submitting this form, you will be contacted by the Pilates Department to Schedule your sessions with your Pilates Trainer. We look forward to meeting you!

Carmen Fermin, Fitness Manager 703-792-8669

Client Agreement (Please read and sign, NOT valid without a signature)

We require 24 hours notice for any cancelled appointments. Please be aware that failure to provide 24 hours notice will result in a loss of the session

2. Client (or Parent/Guardian for those under 14-17yrs) Signature *This question is required.

Clear

Signature of

3. E-mail Address *This question is required. This question requires a valid email address.

4. I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent. *This question is required.

I agree

5. Signature Date This question requires a valid date format of MM/DD/YYYY.

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6. Please Select

Male
Female

7. Parent Name (if under 18)

8. Client Date of Birth This question requires a valid date format of MM/DD/YYYY.

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9. Address

10. City

11. State

12. Zip Code

13. Phone Number

14. Cell Phone Number

15. E-mail Address This question requires a valid email address.