PROACTIVE PILATES - KITSILANO REGISTRATION FORM

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NEW SESSION REGISTRATION FORM

All Core Rehab classes are on hold as Dana is off on maternity leave and will be returning March 2011.  Try the Rehab Pilates class as an alternative until her return.  

Please Note:  Pressing the ENTER button submits the form.  Please use the TAB button or mouse to advance from one field to another.

  1. Please provide the following contact information:
    First Name
    Last Name
    Street Address
    City
    Province
    Postal Code
    Home Phone
    Work Phone
    Cell Phone
    E-mail Required for registration confirmation

     

  2. What Class(es) in the Summer Session are you registering for?

    Summer Session runs June 28th - Aug. 21st, 2010!
    Registration and payment deadline is June 26th!
    Om Pilates - NEW
     Wednesdays 6-6:50pm (8 classes)
     Fridays 10-10:50am  (7 classes) - No class on July 2nd

    Rehab Pilates - NEW
     Tuesday 5-5:50pm (8 classes)
     Wednesday 7-7:50pm (8 classes)

    Pilates Beginner 1 (no prior pilates experience required)
     Tuesdays 6-6:50pm- Beginner 1 (8 classes)
    Wednesdays 10-10:50am - Beginner 1 (8 classes)
    Thursdays 8-8:50pm - Beginner 1 (7 classes)     - No class on July 2nd
    Fridays 9-9:50am - Beginner 1 (7 classes)  - No class on July 2nd

    Pilates     Beginner 2 (prior pilates experience required = one 8 week session minimum)
     Mondays 7-7:50pm - Beginner 2 (7 classes) - No class on Aug. 2nd

    Pilates Beg. 2/Intermediate (prior Pilates experience required = three 8 week sessions minimum)
     Mondays 5-5:50pm - Beg. 2/Int. (7 classes) - No class on Aug. 2nd
     Wednesdays 6:30-7:20am  - Beg. 2/Int. (8 classes)
    Wednesdays 9-9:50am - Beg. 2/Int. (8 classes)
    Thursdays 7-7:50pm - Beg. 2/Int. (7 classes)     - No class on July 1st

    Pilates Intermediate (prior     Pilates experience required = four 8 week sessions minimum)
     Mondays 6-6:50pm - Intermediate (7 classes) - No class on Aug. 2nd
     Tuesdays 7:10-8pm - Intermediate (8 classes)
    Thursdays 6-6:50pm - Intermediate (7 classes)     - No class on July 1st

         Core Challenge (No experience required.)
     Wednesday 8-8:50pm (8 classes)
     Fridays 6:30-7:20am (7 classes)  - No class on July 2nd

    Yoga in the Park     (No experience required. Held at Tatlow Park at W. 3rd and Macdonald.)
    Saturdays 10:30-11:45am (6 classes)

    All Core Rehab classes are on hold as Dana is off on maternity leave and will be returning March 2011.  Try the Rehab Pilates class as an alternative until her return.       
     
  3. What Pilates / Yoga / Core Challenge class package will you be purchasing?  Please total the number of classes in brackets you are registering for and scroll up or down to select the corresponding amount below. As of June 1, 2010,  all prices include HST.
      

    You will be able to complete the online payment using Paypal from the Registration confirmation page once you have completed and submitted this registration form (at the bottom of the page.)
     
  4. How did you hear about us?


  5. If by word of mouth who referred you?
    Name

     

  6. Do you have any health concerns that we should know about?
    Eg. Injuries or pain (please describe), Asthma, Heart conditions or high blood pressure.



     

  7. Are you currently receiving any treatment or therapy? (Eg. Physio, chiro, massage)


  8. Have you had any previous Pilates/Yoga/ Core training?

    Yes No

  9. If Yes please provide a few details (e.g. number of classes, videos etc.)

  10. What are your goals? What do you want to achieve with the classes?