Personal Health Questionnaire plus COVID Disclaimer

Your Personal Health Questionnaire

(and COVID disclaimer)

Your Personal Details

Your Lifestyle

Your Aims

Your Health/Medical Information

How did you hear about Intensys Life?

Important Information and Client Release Statement

Important Information and Client Release Statement Ver 1.1
Please advise your instructor  before commencing any session, if for any reason, your health or your ability to exercise changes. 

Pilates exercises are very safe, but with all forms of exercise, it is prudent to consult your doctor before starting Pilates sessions. 
If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner.  The instructor cannot accept liability for personal injury related to participation in a session if:
-           Your doctor, on health grounds, advised against such exercise
-           You fail to observe instruction on safety and technique
-           Such injury is caused by the negligence of another participant in the class/studio

Exercise should be performed at a pace which feels comfortable for you.  PAIN is the body’s warning system and should NOT BE IGNORED.  Please inform your instructor immediately if you feel any discomfort during a session. 
I understand that IntensysLife Pilates exercises involve hands-on correction and I hereby consent for my instructor to work in this way.   
*Update* During the coronavirus times, a safe distance shall be maintained at all times and hands-on correction will not be used (unless absolutely necessary in the event of safety concerns)

I confirm that I have read and understood the above advice and the information I have given is correct. 
I willingly participate in the practical exercises at my own risk.  I have no physical restrictions, disabilities or any predisposition to sickness or injury that may be aggravated or adversely affected as a result of my participation.  I take full responsibility for any injury, loss or damage to my person or property that may arise directly or indirectly from my participation in the exercises.  I will not seek to penalise, prosecute or claim compensation from the coach for any injury, loss or damage.  I understand that photographs may be taken during classes for promotional purposes, and that I can request not to be included in any photographs.
I understand that the data on this form will be stored safely and used solely by IntensysLife according to GDPR regulations and for my benefit for as long as I continue to take Pilates sessions or classes with IntensysLife.  I understand that I have full access to view what data is held by IntensysLife about me, and that I can ask for this data to be corrected or deleted at any time.

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Thank you so much for completing your Personal Health Questionnaire. Just one more, important step…

COVID Disclaimer

COVID Disclaimer Statement Ver 1.4
Please take the time to read and ensure you understand the following COVID Disclaimer statement.

As a participant of a face-to-face session with Intensys Life (or Tanya of Intensys Life), you must confirm that you understand and accept and abide by the following COVID Disclaimer statement.  If you have any questions, please do not hesitate to ask.

1.	Your personal health questionnaire/client release statement asks you to update us if there is any change to your health.   In addition to this, if you or anyone you have been in close contact with during the last 7 days, has any of the following COVID symptoms, you should notify us immediately BEFORE attending any session with us.
a.	a high temperature – this means you feel hot to touch on your chest or back  
b.	a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
c.	a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

2.	In attending any of our face-to-face sessions you are confirming that you are not exhibiting any coronavirus symptoms and you have no reason to believe that you are infectious in any way.

3.	Any face-to-face sessions that Intensys Life (or Tanya of Intensys Life ) holds during the coronovirus lockdown/guidelines period shall be run in accordance with guidance received from the NHS and UK Government which will include social distancing.  At the beginning of every session we will remind you what precautions we are taking to abide by that advice, and you hereby undertake to follow those precautions without question.

4.	To minimise sharing of resources, you are requested to bring along your own mat to the session and, for indoor sessions, you may  be requested to clean (with provided resources) the area where the mat has been placed.  You hereby agree to this undertaking.

5.	You are attending any of our sessions of your own free will, being aware that despite the fact that we will be taking all reasonable and necessary precautions to keep you safe, there is always the risk that you will contract COVID as a direct or indirect result of your attendance.  In those circumstances you agree that you will not hold us responsible in the unfortunate event that you become ill.

I  confirm that I have read, fully understood and accept the above statement.