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Country Choose... AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSamoaSan MarinoSão Tomé & PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabwe

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Hot swollen joints (required)

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Circulatory problems (DVT, embolus) (required)

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Epilepsy (including petit mal)(required)

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Detached retina (required)

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HIV/Aids

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ME/ chronic fatigue syndrome(required)

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Have you any joint arthritis or pain that is made worse on exercise?(required)

Are you currently undertaking any treatment for a back, neck or joint problem?(required)

Are you pregnant, or had a baby within the last six months?(required)

Have you been referred by a specialist practitioner?(required)

If you have answered ‘yes’ to any of the above questions, please give details below:

Are there any movements which cause you pain (arms above the head, bending forwards?)(required)

Please list your present physical activities and any previous experience (including if you teach Yoga/Pilates).(required)

If you have any concerns about your health or suitability for Pilates/Yoga classes, please consult with your doctor prior to participating in this course. Please wear appropriate/comfortable clothing and we ask that you endeavour to be ready to participate in the class on time. Latecomers will miss the warm-up and be at increased risk to injury and it is at the discretion of the instructor as to whether it is safe for you to participate in the class. It is important to always inform the instructor of any problems as a result of a previous class, or any new injuries picked up between classes. If you participate in an equipment class you will undergo a short induction and whilst under instruction we ask you to use the equipment safely, and under the teachers guidance. Use of the equipment is at your own risk. Please note that payment is per block, refunds or adjustments are not possible if you cannot make any dates during that block.

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Manor Clinic requires the information on this form in order to identify you in our class and billing database; send you email appointment reminders; send you email term dates and other information about classes; contact you in an emergency and send paper records to your address. By signing below you are giving your consent for us to share your data with our Class instructors and other staff within Manor Clinic unless you advise us otherwise. We will not share your information with any other third parties. We will hold your data indefinitely unless you request it is removed from our database.

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By submitting this form, I agree to the following: I comply to the above statement. I declare that the above information is complete and correct. I have read and understood a copy of the Company’s Privacy Statement. I have understood the information regarding the use of the car park and agree that (if applicable) use of the car park is entirely at my own risk.

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