Name
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First Name
Last Name
Email
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Contact Number
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Country
(###)
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Emergency Contact
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First Name
Last Name
Emergency Contact Number
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Country
(###)
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How old are you?
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How did you hear about me/my classes?
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Google/search engine
Word of mouth
Flyers
Instagram
Facebook
Youtube
Other
Which country are you from?
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England
Scotland
Wales
Ireland
France
Spain
Italy
Elsewhere in Europe
U.S.A
Canada
South America
Other
Which town do you live in?
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Are you pregnant? (If yes, please note that my online and in-person classes unless specified, are not pre-natal /post-natal specific classes. If you choose to still attend you are doing so acknowledging this and have had clearance from your doctors to do so.)
Have you any current injuries? (If yes, please write them here)
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Do you have any health-concerns either physical or otherwise, visible or non-visible that I should be aware of? (If yes, please write them here)
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Have you had any significant surgeries that might affect your movement that I should be aware of? (If yes, please write them here)
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Do you have any acute or chronic aches, pains or niggles that I should know about? (If yes, please write them here)
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What are you looking to gain from these classes? (e.g. improved strength, better balance, increased mobility, prevent against injury, help existing pain, improve learning/cognition...etc)
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What does your current weekly activity look like? e.g. running 3 x per week, walking 30 mins a day, sitting at a desk all day, yoga once a week etc)
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How long have you been doing movement based practices (functional yoga, pilates, yoga, HIIT, boxing etc) If so what have they been? And have they been in-person or online?
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Do you like to move to music in your group classes? (If yes, please share the sort of music you like to move to here.)
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Is there any other information that is important for me to be aware of? (If yes, please share it here)
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Client Agreement & Disclaimer
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By ticking this box, I confirm that I have disclosed all relevant medical or health conditions to the best of my knowledge and answered all questions honestly. I understand that Taisie's classes and sessions are not a substitute for medical advice or treatment. I confirm that, if I have any medical conditions that could affect my participation, I have been cleared by my healthcare provider to take part in classes and/or 1:1 sessions.
I give permission for the instructor (Taisie Grant or any assistant supporting her) to use hands-on guidance during in-person sessions to support my alignment and maximise the benefits of the class. I understand that this is optional, and I may withdraw this consent at any time. I agree to inform the instructor (Taisie Grant) of any changes to my health, physical condition, or comfort level with touch or participation.
I take full responsibility for listening to my body, and its signals, and for modifying or stopping any activity that doesn’t feel right, and participating at my own pace. I acknowledge that I am participating in these classes/sessions voluntarily and at my own risk, and I release the instructor (Taisie Grant) and all parties involved from all liability for any injury, health condition, or loss/damage to myself or my personal possessions that may occur during or as a result of working with Taisie Grant and participating in her classes both online or in-person. I also understand that by signing-up I am giving permission to be contacted by Taisie Grant and am aware that I can unsubscribe at any time.
I understand that a minimum of 48 hours’ notice is required to cancel or reschedule a class. Late cancellations or no-shows may be charged in accordance with the cancellation policy.
Print Name
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Date
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