Fill out REGISTRATION FORM and SURVEY below Registration form for on-line session Name and surname E-mail Phone Age Gender GenderWomanMan Language LanguagePolskiAngielskiHiszpański Have you practiced pilates (at least 20 sessions): Have you practiced pilates (at least 20 sessions): YES No Are you interested in: Are you interested in: class at the Studio on-line class Choose time of the day when you can schedule class Choose time of the day when you can schedule classMonday - FridaySaturdaymorning 7:00 - 11:00 a.m.midday 1:00 - 3:00 p.m.evening 5:00 - 9:00 p.m. What kind of physical activity have you practiced and how often? Scheduling the session Scheduling the session The Studio reserves the right to schedule the first session in a 2 week time since receiving the registration form. Please, come to your first class 15 minutes earlier so you can fill in personal questionnaires. Personal data Personal data I declare that all above information are true and I agree to putting my personal data in the database of the DIAMOND S.C company. Statement Statement I got to know with the Diamond Pilates Studio regulations and I will comply with them. Agreement Agreement I agree to processing of my personal data by DIAMOND S.C. Bożena Włodarczyk, Ilona Włodarczyk with headquaters in Warsaw at Powsińska Street 106, 02-903: in order to provide a service or order, to send organizational and marketing information to the e-mail address provided above in the form or to my mobile phone provided above in the form. Consent is voluntary and can be withdrawn at any time by directing a message to the address studio@diamondpilates.pl or akademia@diamondpilates.pl. Number 9 + 2 = Send Survey Survey Name Date How did you find out about our Studio? Do you know Pilates method? Do you know Pilates method? yes, I had min. 20 classes no Where have you practiced Pilates? How long and how often? What kind of equipment and/or what kind of small props have you used? What kind of equipment and/or what kind of small props have you used? Reformer Mat Cadillac Chair Barrels Balls Roller Circle What made you start/return to Pilates? Do you have any diagnosed disease /dysfunction? Do you have any diagnosed disease /dysfunction? Scoliosis Discopathy Osteoporosis Sciatica Stenosis Spondylolisthesis How long and how often this disease ails you? Do you have any other disease or injury that we should know about? Have you had any surgery, for example on your knee or shoulder? What kind and when? Are you pregnant? Are you pregnant? Yes No Have you recently gave brith? (within a year time) Have you recently gave brith? (within a year time) Yes No Do you experience any pain? What part of your body is in pain and how often?? Do you have any of the following diseases? Do you have any of the following diseases? Asthma Diabetes High blood pressure Osteoporosis Do you have any other disease that we should know about? Are you using any therapy (massage, manual therapy, rehabilitation etc)? Do you play any sport? What kind? How long and how often? What type of job do you have? What type of job do you have? Sedentary Standing In constant movement What kind of benefits would you like to accomplish by practicing Pilates regularly? What kind of benefits would you like to accomplish by practicing Pilates regularly? Muscle strenghtening Spine flexibility Toning Correct posture Improve joint mobility Improve coordination Get rid of stress Well-being Improve breath quality Improve balance Number 1 + 12 = Send
