Booking Form Step 1 of 2 50% Classes and personal tuitionWhat do you want to book?*Taster classBlock of 4 classesPersonal tuitionWhich class do you want to book?* Open to All - Beginners - Tue 11.15am, Bushmead Church Open to All - Beginners - Tue 6.30pm, Bushmead Hub Open to All - Beginners - Sat 8.30am, Bushmead Hub Over 50s - Beginners - Tue 10am, Bushmead Church Ladies Only - Beginners - Weds 7pm, Luton Sixth Form ContactName*Date of birth (dd/mm/yy)*Email* Phone* Address line 1*Address line 2*Address line 3Postcode* Next of kin*Next of kin contact number* Health1. Do you have any illnesses and/or disabilities?*YesNoPlease provide details*2. Do you have a bone, joint, muscle or other problem that could be made worse by a change in your physical activity?*YesNoPlease provide details*3. Are you pregnant or have you been pregnant in the last 6 months?*YesNoPlease provide details*4. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*YesNoPlease provide details*5. Do you feel pain in your chest when you do physical activity?*YesNoPlease provide details*6. In the past month, have you had a chest pain when you were not doing physical activity?*YesNoPlease provide details*7. Do you lose balance because of dizziness or do you ever lose consciousness?*YesNoPlease provide details*8. Is your doctor currently prescribing you drugs for your blood pressure or heart?*YesNoPlease provide details*9. Are you currently visiting a health professional? eg doctor, physiotherapist, osteopath, chiropractor*YesNoPlease provide details*10. Do you know of any reason why you should not do physical activity?*YesNoPlease provide details*Additional informationWhat is your main reason for starting Pilates?*How did you hear about Kat Pilates?* Word of mouth Facebook Online search Flyer Poster Other Other - Please state*ConsentBy checking this box I confirm the following:*I have answered honestly all of the questions in the booking form. I will notify Kathryn Knights (or a replacement instructor) of any changes to my past or current state of health. I voluntarily participate with full knowledge that all exercise carries a risk of injury or, in extreme cases, death. I hold Kathryn Knights (or a replacement instructor) free of any and all liability for any injury or death that may result from my participation. I agree This iframe contains the logic required to handle Ajax powered Gravity Forms.