I’m so excited to meet you!But first - the following two forms must be filled out before your first session. Client Intake and Studio Policies PERSONAL INFORMATION AND POLICIES Today's date * MM DD YYYY Name * First Name Last Name Email * Phone Number * Gender * Pronouns * She/her He/his They/them Other Date of birth * MM DD YYYY Occupation * Referred By Emergency Contact Name * Emergency Contact Relationship * Emergency Contact Phone Number * Hobbies/recreational activities and frequency Do you have any previous experience with Pilates? If so, where? Personal fitness goals Medications Previous injuries Previous surgeries Are you currently receiving any professional health care services? i.e. Chiropractic, Massage Therapy, Physical Therapy, etc. Are you currently experiencing any physical problems or limitations? If yes, please explain. Medical conditions i.e. seizure disorder, herniated disk, osteoporosis, arthritis, etc. Other relevant medical and/or personal information Policies Sessions and Booking * All sessions are 55 minutes, unless otherwise agreed upon. All booking and payment is done directly with the owner of Flipside Movement LLC, Mikayla Savuto, via email, online booking, or phone. By checking "Agree" you are acknowledging that you have read and agree to this policy. Agree Payment * Payment will be made directly to Flipside Movement LLC / Mikayla Savuto via cash, Venmo, Zelle, or credit/debit card. Debit cards will be processed as credit. By checking "Agree" you are acknowledging that you have read and agree to this policy. Agree Refunds and Expirations * All purchases expire one year after date of purchase. There are no refunds; all sales are final. By checking "Agree" you are acknowledging that you have read and agree to this policy. Agree Cancellation Policy * If you are unable to attend your scheduled in-person Pilates private, Pilates duet, or Pilates virtual session for any reason, you must cancel at least 24 hours prior to the start of the session. If you do not cancel at least 24 hours prior to the session, you will be responsible for a single session payment or a session will be deducted from your current package. Schedule permitting, same-calendar day reschedules are allowed. See reschedule policy below. If you are unable to attend your scheduled In-Home Pilates private, In-Home Pilates duet, or In-Home Pilates Group session for any reason, you must cancel at least 48 hours prior to the start of the session. If you do not cancel at least 48 hours prior to the session, you will be responsible for a single session payment or a session will be deducted from your current package. Schedule permitting, same-calendar day reschedules are allowed. See reschedule policy below. If you are unable to attend your Pilates Private Group Class, Pilates Private Room Private Session, or Pilates Private Room Duet Session for any reason, you must cancel at least 48 hours prior to the start of the session. If you do not cancel at least 48 hours prior to the session, you will be responsible for a single session payment or a session will be deducted from your current package. Complimentary same-calendar day reschedules are NOT available for Private Room bookings. Complimentary reschedules: Schedule permitting, sessions can be rescheduled for a different time on the same calendar day up to 2 hours prior to the start of your scheduled session at no additional change. If a same-day reschedule cannot be accommodated for any reason, you will be responsible for a single session payment or a session will be deducted from your current package. Non-Complimentary reschedules: If you request and are granted a same-day reschedule less than 2 hours prior to the start of your originally scheduled session, you will be responsible for 2 single session payments or 2 sessions will be deducted from your current package. If a same-day reschedule cannot be accommodated for any reason, you will be responsible for a single session payment or a session will be deducted from your current package. By checking "Agree" you are acknowledging that you have read and agree to this policy. Agree Referrals * Referrals are the best compliment I can get! Refer a new client to me, and once they have completed 10 single sessions or purchased a 10-pack of sessions, you will receive a free session as a thank-you! Awesome! Thank you! Please make sure you have also filled out the Waiver and Release of Liability. Waiver and Release of Liability WAIVER AND RELEASE OF LIABILITY Name of Participant * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date * MM DD YYYY Waiver * In consideration of the risk of injury while participating in Pilates (the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Flipside Movement LLC, located at 900 Broadway #808, New York, NY 10003 their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY. I agree to indemnify and hold harmless Flipside Movement LLC against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Flipside Movement LLC incurs any of these types of expenses, I agree to reimburse Flipside Movement LLC. I acknowledge that Flipside Movement LLC and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Flipside Movement LLC. I acknowledge that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers of the event. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE FLIPSIDE MOVEMENT LLC AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST FLIPSIDE MOVEMENT LLC FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of Flipside Movement LLC, its agents, and employees. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. This Agreement was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant, named and defined above, and Flipside Movement LLC agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. In the event of an emergency, please contact the following person(s), "Emergency Contacts", in the order they are presented below. I, the named Participant, affirm that I am of the age of 18 years or older, and that by checking "Agree" below I affirm that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will. Agree Emergency contact name * First Name Last Name Emergency contact relationship * Emergency contact phone number * Emergency contact name First Name Last Name Emergency contact relationship Emergency contact phone number Emergency contact name First Name Last Name Emergency contact relationship Emergency contact phone number Thank you! Please make sure you have also filled out the Personal Information and Policies.
