Studio P LLC

Pilates and Aerial Yoga

Informed Consent

Physical Fitness Program

General Statement of Program Objectives and Procedures: I understand that this physical fitness program may include exercises to build the cardio respiratory system (heart and lungs), the musculoskeletal system (muscle endurance, strength and flexibility), and to improve body composition (decrease of body fat in individuals needing to lose fat, with an increase in weight of muscle and bone). Exercises may include aerobic activities (running, walking, bicycle riding, etc.), calisthenics and weight lifting to improve muscular strength and endurance, and flexibility exercises to improve joint range of motion.

Description of potential Risks: I understand that the reaction of the heart, lung, and blood vessel system to such exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart rate, ineffective functioning of the heart, and in rare instances, heart attacks. Use of the weight lifting equipment, and engaging in heavy body calisthenics, can lead to musculoskeletal strains, pain, and injury if adequate warm-up, gradual progression and safety procedures are not followed.

Description of Potential Benefits: I understand that a program of regular exercise for the heart and lungs, muscles and joints, has many associated benefits. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement in psychological function, and a decrease in risk of heart disease.

Package Pricing agreement: I understand that when purchasing a package of multiple classes or sessions, these classes and sessions will expire one year from the purchase date and no refunds for remaining classes or sessions will be issued after this expiration date.

Cancelation Policy: I understand that all appointments and reservations must be cancelled at least 24 hours ahead of the appointment or class time and that late cancelation and no shows are subject to a fee or package being charged for that session or class.

I have read the foregoing information and understand it; any questions, which may have occurred to me, have been answered to my satisfaction. I understand that I am free to withdraw from this program without prejudice at any time I desire. I am also free to deny answers to specific items to questions during interviews or when filling out questionnaires. The information that is obtained will be treated as privileged and confidential and will not be released or revealed to any person other than my physician without my expressed written consent. The information obtained, however, may be used for a statistical or scientific purpose with my right of privacy retained.

Saturday, April 26th, 2025