Pilates Reformer Interest Form - MUSC Wellness Center

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

M8uwYupPpYen8BbdKQpMZVsV6R6TCf7AeoiVf7fHcDGXWsCJJf6sSjAgAkUfRCsLzfX25UNg9DANZiwZ9Yr7

Please complete the Pilates Reformer Interest form below. We hope to see you in the studio soon!

Full Name

* must provide value

E-mail

* must provide value

Do you have a current membership at the MUSC Wellness Center?

* must provide value

Yes

reset

Date of Birth

* must provide value

Street Address

* must provide value

City

* must provide value

State

* must provide value

Zip Code

* must provide value

Mobile Number

* must provide value

Are you interested in one-on-one reformer training or duo (2) reformer training?

* must provide value

Is there a specific Pilates Reformer Trainer you would like to work with?

* must provide value

Do you have prior class experience on Pilates Reformers?

* must provide value

Yes

reset

Do you have any health conditions that should be considered?

* must provide value

Osteoporosis/Osteopenia

Current or Previous Back Pain/Injury

Pregnancy

Arthritis

Cardiovascular/Respiratory Condition

Other

If other, please include the health conditions below:

Expand

Pilates Reformer Training Agreement

Pilates Reformer instruction must be provided by MUSC Wellness Center employees only. Outside instruction is strictly prohibited.

All payments for facility use, programs, services (including personal training or fee-based fitness programs), and classes must be made directly to the Wellness Center. All payments are non-refundable and cannot be prorated.

Pilates Reformer sessions or classes canceled within 24 hours of the scheduled time will be redeemed and cannot be rescheduled unless the instructor and management provide an exception for unusual circumstances.

No call/no shows for Pilates Reformer sessions or classes will be redeemed and cannot be rescheduled unless the instructor and management provide an exception for unusual circumstances.

Transferring unused Pilates Reformer sessions or classes to an immediate family member may be allowed at the discretion of the Wellness Center Director.

Pilates Reformer sessions must be used within 12 months from the date of purchase.

55-minute sessions cannot be split into shorter session intervals.

If the instructor must cancel a session with a client, an effort to notify the client must be made immediately. All instructors are expected to be on time for scheduled sessions. Any lost time due to employee tardiness is owed back to the client.

Release of Liability and Waiver Agreement

In consideration of my obtaining guest privileges and being allowed to use the facilities and equipment of the MUSC Wellness Center (MUSC), I hereby release, waive, discharge and agree not to sue MUSC and its affiliates, its trustees, officers, agents or employees (hereinafter referred to as "Releasees") from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage or injury, including but not limited to those posed by COVID-19, including death, that may be sustained by me, arising in connection with my return or participation in activity at the MUSC Wellness Center, or while in or upon the premises. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death that may be sustained by me, or any loss or damage to property owned by me, as a result of my return/participation. I further hereby agree to indemnify and save and hold harmless MUSC, from any loss, liability, damage or costs that may incur as a result of my participation. It is my express intent that this Release shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased.

I understand that strength, flexibility, sports and aerobic exercise, including the use of equipment involves risk of injury. I am voluntarily participating in these activities and using the equipment with knowledge of the dangers involved. I assume the risk of injury that might happen to me using the facilities and participating in the programs of (MUSC).

I represent to (MUSC) that I am physically fit to participate in the activities and programs of the Center and that I will not extend myself beyond my abilities, or if I do so, it will be at my own risk.

I have been informed that I should consult with a physician concerning my participating in physical activity and obtain for a physician, advice as to how I should participate in relationship to my state of physical condition. I have also been informed that I should periodically update my state of physical condition with a physician. I either have obtained such advice from a physician or acknowledge that I have decided to participate in physical activities without obtaining the advice of a physician.

All policies must be followed by members and guests at all times. Any behavior deemed by Management to be adverse to the enjoyment of the facility by others may result in termination of contract.

I understand that the Waiver and Release of Liability above stated is in broad terms. If any portion of this Waiver and Release of Liability is held invalid, the remainder will continue in effect.

I certify that I am age 18 or older. I acknowledge that I have carefully read this document in its entirety and have had the opportunity to ask questions concerning this document before signing, that I understand and agree to comply with its terms and conditions, and that I have signed it knowingly and voluntarily.

Add signature

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.