Informed Consent

The Pilates class will introduce you to the Pilates technique used primarily to improve core strength and flexibility.

Each session will begin by mobilising, then warming up the joints to prepare for the main workout. The main workout is for your core muscles but will challenge most other major muscle groups too, helping to lengthen, strengthen and mobilise you. Stretches and relaxation mean you’ve completed the class.

As with any activities, there are benefits and risks. The benefits include:  reducing risks of Coronary Heart Disease and osteoporosis.  Weight management and control  Improving posture, with fewer aches and pains  Helping to relieve stress and anxiety  Increasing and maintaining the strength and endurance of muscles  Increasing and maintaining range of movement in joints  Strengthening ligaments, tendons, bones and joints making them less prone to injury

The main risk is that of injury. The class has been designed to be safe and effective. Please inform your instructor if there is any reason why you shouldn’t perform any specific activity, such as a recent operation. If you feel unwell, or uncomfortable at anytime your instructor will advise you. You will be encouraged to work at your own level so listen to your body to hear what it is saying to you. You may feel slightly out of breath at times, or specific muscles working, these are good. If you feel unable to breathe or feel pain then tell your instructor so they can help you take immediate action.

All exercises will be explained and, where appropriate, demonstrated to you. If you are unsure of anything please ask so that you are able to get the most out of the session and prevent injury. Your participation is voluntary – your feedback is welcome to make the class interesting and fun, and to keep you motivated.

All information given to your instructor is, and remains confidential. If you have any concerns about this please speak to the instructor.

I have had the content and purpose of the class, benefits and risks explained to me. I am willing to take part in the class, but may choose to withdraw at any time.

Signed ______Printed name ______Witnessed* ______Printed name ______Date ______

(N.B. * Witness can be anyone who sees you sign this form, but NOT the instructor) Physical Activity Readiness Questionnaire (PARQ)

If you are planning to take part in an exercise class, please answer the questions below. If you are over 18 years old the questionnaire will tell you if you should check with your doctor before you start. Your instructor will treat all information confidentially.

Has your doctor ever said that you have a heart condition and that you should Yes No only do physical activity recommended by a doctor? Do you ever feel pain in your chest when you do physical activity? Yes No Have you ever had chest pain when you are not doing physical activity? Yes No Do you ever feel faint or have spells of dizziness? Yes No Do you have a joint problem that could be made worse by exercise? If so what? Yes No

Have you ever been told that you have high blood pressure? Yes No Are you currently taking any medication of which the instructor should be made Yes No aware? If so what & why?

Are you pregnant or have you had a baby in the last 6 months? Yes No Is there any other reason why you should not participate in physical activity? If Yes No so what?

If you have answered Yes to one or more questions talk with your instructor. You may need to speak with your doctor before you join in a class.

If you have answered No to all questions – remember to begin slowly and to build up gradually.

PLEASE NOTE: If your health changes so that you subsequently answer Yes to any of the above questions, inform your instructor immediately. If you feel unwell because of temporary illness such as cold or flu – delay becoming more active and wait until you are better.

What are your motives for exercising?

I have read, understood and completed this questionnaire:

Name:______Signature: ______Address:______Phone no: ______Date: ______Email address (if applicable) ______Emergency contact name & phone no: ______

If you want to be reminded when class restart each term, as well as other information about classes and services Jill provides, please tick here