New Client Intake Form


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Do you have a PRIMARY injury or area of concern that we should know about?

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Do you have a SECONDARY injury or area of concern that we should know about?

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PRIMARY

Osteoporosis
Osteoarthritis
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Parkinson’s Disease
Rheumatoid Arthritis
Chronic Pain
Chronic Fatigue Syndrome
History of Cancer
Sprain
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SECONDARY

Osteoporosis
Osteoarthritis
Multiple sclerosis
Parkinson’s Disease
Rheumatoid Arthritis
Chronic Pain
Chronic Fatigue Syndrome
History of Cancer
Sprain
Degenerative Disc Disease
Tendinitis
Bursitis
Pregnancy
Scoliosis
Hypermobility syndromes
Fibromyalgia
Other
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Have you had any past training with Pilates?
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Are you working with a physical therapist, chiropractor, or healthcare provider?
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Studio Policy and Medical Liability Waiver

Please agree to our studio policies by checking the boxes below.


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All sessions are by appointment only and paid for at the instructor’s rate.

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24 Hour Notice

To offer the best experience for each client, please give 24 hours notice if you are unable to keep your scheduled session. Cancelled or changed sessions within 24 hours will be charged in full.


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All packages expire in six months from date of purchase and are non-refundable.

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Safekeeping and Voluntary Participation

In checking the box, I agree that Pacific Northwest Pilates (PNWP) is in no way responsible for the safekeeping of my personal belongings while I attend classes or courses at the studio. I understand that workouts at PNWP may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.


Submitting this form indicates that you have read and agree to the Pacific Northwest Pilates’ Studio Registration Policies and Liability Agreement. Thank you for your submission and we will be in contact with you shortly to set up your initial session.

Pacific Northwest Pilates Client Policies & Studio Information

Pacific Northwest Pilates (PNWP) is a specialty Pilates studio. We exist to create specific, personalized fitness HEAL, MOVE, and TRAIN programs for our clients. To help us evaluate your needs, you’ll begin with a private session. Your certified instructor will help you determine the best Pilates path—private and/or group sessions— to reach your goals.

Your First Session at PNWP
To reserve your first session at PNWP, please fill out a new client intake form or call the studio. Private sessions must be booked through our front desk. To schedule and reserve your first appointment, we'll request a payment card be held on file.

Cancellations, Payments, and Schedule Changes
All classes and private sessions are by appointment only. After your first appointment, you may purchase private and group class packages.

24-hour advance notice is required to change or cancel an appointment without charge. All private and group appointments may be cancelled by phone, email, or in person.

Group classes may be canceled online with 24 hour advance notice.

In the event an instructor has to cancel a class, we or your instructor will make every attempt to notify you within 24 hours. Pacific Northwest Pilates reserves the right to cancel any class due to an emergency.

All private or group packages expire six months from the date of purchase. Packages are fully transferable, with 24-hour notice, but are not refundable—you may apply the value of an unused credit to another service or product at our studio for yourself or a friend.

A $25 fee will be applied to any returned checks or declined credit card payments.

General PNWP Studio Information and Etiquette
To achieve the results you are seeking, we recommend attending private sessions or group classes two to three times per week, and augment with independent, at home work using simple props and tips from your in-studio sessions. The Pilates exercise methods taught as Pacific Northwest Pilates may be done daily.

Pacific Northwest Pilates is a Pilates training center and occasionally our education students observe sessions in the studio. If you are uncomfortable about being observed, please notify your instructor.

Our instructors are highly qualified fitness professionals. To benefit from different teaching styles, we recommend training with more than one instructor.

Wear comfortable, well-fitting exercise clothes. Baggy tops and pants may obscure your body and make it difficult for your instructor to correct your form and alignment.

Many people are comfortable wearing socks in the studio. Clean shoes may be advised for clients who use orthotics.

Kindly refrain from using cell phones in the studio.

Many clients and instructors are sensitive to fragrances. Please avoid wearing perfumes or scents at the studio.

If you are practicing Pilates before pregnancy, you can safely continue through your pregnancy with permission from your doctor.

Pacific Northwest Pilates may require you to wear a mask and/or show proof of vaccination to attend in-studio group or individual classes.


Pacific Northwest Pilates Education Policies and Procedures

Additional Fees

  • Returned check or declined credit card fee $25.00
  • Make-up private IT session $120.00/hr
  • Make-up Lead IT session $140.00/hr
  • Make-up private IT session w/Master Instructors $160.00/hr
  • Exams Mat or Reformer only $300, Mat and Reformer $325, Full Certification $350 Written Exam Retake $200

Payments

At Pacific Northwest Pilates Education (PNWPE), full tuition is due to reserve your spot in a course.

Admission Requirements for Intensive Fitness Program

  • Working knowledge of functional anatomy and prior participation in an anatomy course that covers in detail the human musculoskeletal system and includes muscle attachments, actions and basic biomechanics
  • Functional Anatomy is required for all students who have not taken an anatomy course within the past 3 years
  • A minimum of 30 hours of participation in Pilates classes or private sessions
  • 3+ years of teaching movement or fitness is recommended

Admission Requirements for Rehab Program

Licensed and certified healthcare professionals must submit a copy of their current license when applying. We accept applications from the following professionals:

  • Physical Therapists/Physiotherapists
  • Occupational Therapists
  • Chiropractors
  • Osteopaths
  • Medical or Sports Medicine Doctors
  • PTA & OTA Assistants
  • Professionals with minimum of 2 years of full time study from a certifying/licensing/degree granting institution in anatomy, physiology, injury prevention, exercise prescription with clinical experience, who have been granted the right to assess, diagnose, treat, and prescribe exercise for the rehabilitation and/or prevention of injuries
  • Final year health professional student

Attendance

Attendance is mandatory.

  • An absence request must be submitted in writing two weeks prior to the PNWPE Manager
  • All missed time must be rescheduled by the student and completed within six months from the final day of the course
  • Students may be required to schedule private sessions with an Instructor Trainer—at an additional cost— to make up class time. See Additional Fees.
  • It is the student’s responsibility to seek out and complete all lessons and assignments covered during such absences
  • In the event of an emergency absence (illness, bereavement, family emergency or transportation), students are responsible for rescheduling all missed course work at their own additional expense.

Appearance and Dress

A professional appearance is required of all students while observing and teaching at PNWPE. Leggings, sweatpants, tights and shorts are permissible. Skirts and low fitting blouses are unacceptable attire while teaching and demonstrating exercises. Students are expected to dress professionally and discretely while observing class sessions or practice teaching.

Video or Audio Recording

Audio or video recordings of courses being taught is strictly prohibited. If there are exceptional circumstances that make this necessary, the student must apply for and receive express written permission from the Merrithew Senior Program Director of Education and sign a contract restricting its use. This policy is to help avoid any infringement on intellectual property.

Observation, Practice Teaching, and Physical Review Policy

It is imperative while observing that one remains quiet and respectful of all clients and teachers at work. Any questions or comments, while encouraged, should be saved until the session has ended.

Please do not use cell phones while observing or teaching sessions.

Each student is expected to act in ways which create a positive teaching atmosphere at PNWPE.

All observation, practice teaching, and physical review hours are mandatory and documentation is collected on your determined exam date.

Auditing Courses

One of the benefits of taking courses at PNWPE is the opportunity to audit courses free of additional charge for up to five years. Only PNWPE students can audit courses they have previously taken at our training center.

Studio & Equipment Use

PNWPE encourages students to use the studio and equipment to practice and prepare for examinations. Complementary use of the studio is available. Please call ahead to reserve space.

Exams

For the Intensive Fitness program, the exam is given in two parts: a written exam that includes multiple-choice and essay questions and a practical exam. It is recommended that the written exam be taken before the practical, but in either case, both sections of the exam must be taken within a week of each other and within six (6) months from the last day of training.

For all Rehab program students, there is only a practical exam.

Exam fees are non-refundable. If the student fails to pass either the written or practical exam, an additional exam fee will be charged at the time of reexamination.

All observation, practice teaching, and physical review hours are mandatory and documentation is submitted when you take your exam.

Reinstatement Policy

If a student has exceeded the six-month deadline from their last STOTT PILATES® course and wish to complete their examination, they must complete an exam reinstatement session with an Instructor Trainer to reinstate their eligibility. Material covered will be specific to their needs to better prepare them for the exam. The number of hours required is based on the course material that must be covered and the demands of the course repertoire. The MINIMUM private session requirements are:

  • Matwork – 1 hour
  • Reformer – 1 hour
  • Matwork & Reformer – 1 to 2 hours
  • Matwork, Reformer & CCB– 2 to 3 hours
  • Rehab program requirements are same as above

The Instructor Trainer may recommend further privates or study as preparation.

Please note:

  • The reinstatement is valid for 60 days and will not provide the student an additional six months to complete their examination
  • Only STOTT PILATES® Courses can grant students an additional 6 months to examine.
  • A STOTT PILATES® workshop does not reinstate a student’s eligibility to sit their exam. Other MerrithewTM courses such as ZEN·GA®, Total Barre®, Halo® Training, Merrithew Fascial Movement courses & workshops also do not reinstate a student’s eligibility to sit for their exam.
  • The student must complete the exam reinstatement session privately, not in a group.

Refund Policy

If a student finds it necessary to withdraw the following policies apply:

  • A student may withdraw and receive a full refund from any course two weeks (14 days) prior to the start of the course.
  • If a student cancels, withdraws, or reschedules a course in less than two weeks prior to a course, they will be charged 25% of the total course tuition.
  • PNWPE reserves the right to dismiss a student from the program after fair warning, as discussed in the dismissal policies. There will be no refund of tuition under these conditions.

Dismissal

A student who receives multiple warnings may be subject to dismissal. Students may be given a warning for any of the following reasons.

  • Tardy attendance to class
  • Unprofessional appearance or dress while observing, practicing or teaching at PNWPE
  • Unprofessional behavior towards clients, instructors or fellow students
  • Solicitation of PNWPE clients

Injury

PNWPE courses are intensive and physically demanding. PNWPE reserves the right to request that students postpone training due to an injury.

Pregnancy

PNWPE is unable to accept pregnant students into a course. Under certain circumstances permission may be granted for select workshops. Requests must be submitted in writing at least 30 days prior to the workshop date. Merrithew and PNWPE reserve the right to determine the reasonableness of the accommodation requested.

Course Cancellations

In the unlikely event that our education team needs to cancel a certification course, all students will be refunded 100% of the full tuition less the number of hours taught. In this case, all manuals and videos must be returned or purchased at their full retail price. Returned retail items must be in re-sellable condition. PNWPE will attempt to resume the program at a later date. In this case, any student resuming the certification will not be subject to admission requirements or fees.


Pacific Northwest Pilates Workshop Policies and Procedures

Workshops and Annual Conference

  • Full payment secures your spot and confirms registration.
  • Full refunds available until two weeks (14 days) prior to the workshop.
  • Changes and cancellations made in the two-week period prior to the workshop are not eligible for a refund.
  • For the annual conference, all changes or cancellations ​must be made in the two-week period prior to the day of your workshop​.
  • Special discounts may be offered on workshop packages. Cancellation of any part will negate the special discount; each workshop will revert to full price.
  • Workshops cannot be audited.

Please Note:

  • Some workshops may require an additional fee for materials.
  • Tax may be applied to retail items purchased at out-of-state training facilities.
  • Pacific Northwest Pilates Education (PNWPE) reserves the right to cancel a workshop up to two weeks (14 days) before the start date.

    • In the event of workshop cancellation, registrants are eligible for a full refund.
    • Alternatively, funds may be applied to a future course or workshop at PNWPE.
  • Continuing education credits are listed for each workshop on our website. Review credits offered for each workshop in advance to make sure you will meet your annual goals.
  • Pacific Northwest Pilates may require you to wear a mask and/or show proof of vaccination to attend in-studio, education courses, workshops, group or individual classes.

Pacific Northwest Pilates (PNWP) Medical Waiver

The instructors at Pacific Northwest Pilates (PNWP) are trained in a variety of exercise systems and specialties and can develop a STOTT PILATES, Yoga, Somatics, Barre exercise, Franklin Method, Melt, ZENGA, Fascial Movement Exercise, or other program (“hereinafter Pilates, Yoga or other Program”) for you.

The Pilates, Yoga or other Programs of exercise may or may not be beneficial to you. It is advised that you first consult with your physician about any injuries or existing medical conditions, past or present, before enrolling in any of our programs. We would be happy to speak with your physician or call for a release form on your behalf.

PLEASE READ CAREFULLY! THIS IS A RELEASE AND WAIVER OF CERTAIN LEGAL RIGHTS.

Participant understands that Pilates, Yoga or other Program involve physical exertion; are strenuous, and that injuries may occur when participating in such activities. Participant accepts and assumes the risks associated with Pilates, Yoga or other Program, including, but not limited to, equipment malfunction or failure, overexertion, inability to perform suggested exercises or maneuvers, physical or mental conditions that impede the ability to properly perform suggested exercises or maneuvers, failure to properly operate equipment, and failure to follow instructions. Participant hereby freely and expressly assumes all risk of property damage, injury, and death associated with Pilates, Yoga or other Program.

Participant understands that it is his/her responsibility to consult with a physician prior to and regarding participation in Pilates, Yoga or other Program. Participant represents and warrants that he/she has no physical or mental condition that would prevent full participation in Pilates, Yoga, or other Program. Participant agrees to inform his/her instructor immediately of any physical or mental condition that would prevent his/her full participation in Pilates, Yoga or other Program.

In consideration for participation, receiving instruction in a group, private or semi-private lessons, workshops or certification programs and using the equipment and facilities, Participant hereby agrees to release, hold harmless, and indemnify Pacific Northwest Pilates and its owners, partners, employees, independent contractors, directors, officers, agents, instructors, licensees and affiliates (“PNWP”) from any and all claims by or on behalf of Participant against PNWP arising directly or indirectly out of Participant’s participation in Pilates, Yoga or Program, use of any PNWP equipment or facilities. This release includes claims and liabilities arising from any cause whatsoever, including, but not limited to, negligence on the part of PNWP. This release is binding upon Participant, and Participant’s heirs, assigns, and legal representatives.

If signing on behalf of a minor Participant, Parent/Guardian accepts full responsibility for any medical expenses incurred due to the minor’s participation in Pilates or Yoga and agrees to release, hold harmless, and indemnify (including costs and attorney’s fees) PNWP for any claims brought by or on behalf of the minor.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.


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To register for your first session at PNWP, we need a credit card on file. This information will be stored securely in your profile and your card will not be charged until you've booked a session with us.
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Date: 7/19/2024

Time: 11:15 AM


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Date: 7/19/2024

Time: 11:15 AM


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