Name: PRIVATE CLASS FIRST TRIAL REGISTRATION (MY)
SKU: 104092
Price: 199.00 MYR
Availability: InStock

Which studio you would like to go? *

Bukit Bintang

Bangsar

Which instructor you want to train with for the first trial? *

Private 1 to 1

Private 1 to 2 (Duet)

Private small group (Max 4 pax)

Private 1 to 1 *

Master Trainer (+RM150.00)

Other Trainer

Private 1 to 2 (Duet) *

Master Trainer (+RM200.00)

Other Trainer (+RM100.00)

Private small group (Max 4 pax) *

Master Trainer (+RM300.00)

Other Trainer (+RM200.00)

How do you know about us? *

Have you done Pilates before? *

Yes (Mat)

Yes (Machine)

Yes (Both)

No

GOAL TO ACHIEVE: *

Others GOAL TO ACHIEVE (Please specify)

Others Medical History (Please specify)

FOR POST NATAL RECOVERY, PLEASE SPECIFY YOUR CHILD BIRTH METHOD *

NATURAL BIRTH

CAESAREAN BIRTH

EPISIOTOMY

Others

Others POST NATAL RECOVERY (Please specify)

HOW LONG AFTER BIRTH? *

IF YOU ARE PREGNANT, PLEASE STATE WEEKS OF PREGNANCY.

1. How many times have you previously given birth?

2. Did you take any drugs or nutritional supplements during your previous pregnancies?

3. Is there a history of hereditary diseases in your family?

4. Were you engaged in any exercise regimen before discovering your current pregnancy?

5. Have you been engaging in any exercise since finding out about your pregnancy?

6. Did you practice Pilates or yoga prior to becoming pregnant?

7. Do you have any muscular or joint-related conditions?

8. Are there any diseases or conditions that may impact your ability to exercise?

9. Have you ever had any heart or lung diseases?

10. Have you been diagnosed with diabetes either before or after pregnancy?

11. Do you suffer from hypertension?

12. Have you experienced premature delivery in the past?

13. Have you ever had complete placental coverage or been in close proximity to the cervix?

14. Do you have any limb disabilities or musculoskeletal disorders?

15. Have you undergone three or more abortions?

16. Did you experience chest pain or vaginal bleeding during your previous pregnancies?

17. Have you given birth to twins or multiple twins?

Are you taking any prescribed medicine? *

Yes

No

Do you feel pain in your chest when you do physical activity? *

Yes

No

In the past month, have you had chest pain when you were not doing physical activity? *

Yes

No

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

No

Do you have a bone or joint problem (eg: back, knee, or hip) that could be made worse by a change in your physical activity? *

Yes

No

Is your doctor currently prescribing drugs (eg: water pills) for your blood pressure or heart condition? *

Yes

No

Do you know of any other reason why you should not do physical activity? *

Yes

No

Acknowledgement of studio policies and procedures, risk and release of liability

1. I understand that I undertake the exercise program and use all the facilities and equipments at Bhumi Lifestyle Sdn Bhd at my own risk.

2. Prior to exercising I must disclose any health conditions and have obtained clearance from my general practitioner with regards to such conditions. I take it upon myself to discuss any changes to my current health with my instructor/ therapist.

3. I recognize that the instructor is not able to provide me with medical advice with regard to my medical fitness and that the information provided is used as a guideline to limitations of my ability to exercise.

4. I confirm that I have reached the Legal Age in Malaysia, the place in which I am participate in classes held or organized by Bhumi Lifestyle Sdn Bhd and if I am under the age of 21, my legal guardian will sign this release and waiver on my behalf.

5. I consent to treatment modalities explained to me and considered appropriate.

6. Cancellation Policy: I agree to give 12 hours' notice if I need to cancel or reschedule appointment or group class session, otherwise resulting in a lost and non-refundable session even if I made the booking in less than 12 hours.

*

I declare the above information to be true and hereby give my acknowledgement and consent to Bhumi Lifestyle Sdn Bhd to use my personal data for the purpose of providing its services to me. I shall abide by the policies and procedures stipulated by Bhumi Lifestyle Sdn Bhd.

PRIVATE CLASS FIRST TRIAL REGISTRATION (MY)

Class & Service

Event & Workshop

About

Contact

+6011 7077 9999

+65 96667960

PRIVATE CLASS FIRST TRIAL REGISTRATION (MY)

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