Pilates Reformer New Client Consultation/Package Form

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

This appointment is a great way for you to get started on your Pilates journey! During your session, we will demonstrate proper use of the Pilates equipment and assess your fitness level to prepare you to integrate into a group class. Prior to the start of any exercise program, please consult with a physician.

After submitting this form, you will be contacted by a member of our team to schedule your sessions with your Pilates Trainer. We look forward to meeting you!

Carmen Fermin, Fitness Manager: 703-792-8669

1. Select Option *This question is required.

2. Which day(s) of the week do you prefer? *This question is required.

3. Which time(s) do you prefer? *This question is required.

Early Morning (6am - 8am)
Morning (8am - Noon)
Afternoon (Noon - 4pm)
Evening (4pm - 8pm)

Client Agreement/Cancellation Policy (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.

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

Clear

Signature of

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

6. 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

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

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8. Please Select

Male
Female

9. Parent Name (if under 18)

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

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11. Address

12. City

13. State

14. Zip Code

15. Phone Number

16. Cell Phone Number

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