"; throw new Exception($error); } foreach ($_POST as $key => $value) { if (preg_match('/www\.|http:|https:/i', $value)) { $error .= "URLs are not allowed!\n
"; throw new Exception($error); break; } } if (empty($_POST['Name'])) { $error .= "Please tell us your name\n
"; } if (empty($_POST['Phone'])) { $error .= "Please enter a phone number\n
"; } if (empty($_POST['Email'])) { $error .= "Please enter a valid email address\n
"; } if (empty($_POST['Address'])) { $error .= "Please enter your address\n
"; } if ($_POST['Info consent'] != "on") { $error .= "You need to consent to us collecting the information or we can't process your enquiry\n
"; } if (empty($_POST['Date of Birth'])) { $error .= "Please enter your date of birth\n
"; } if (empty($_POST['Emergency'])) { $error .= "Please enter emergency contact details\n
"; } if ($_POST['Terms'] != "on") { $error .= "You must read and agree our terms\n
"; } if (!empty($error)) { throw new Exception($error); } $message .= $eol; $message .= "IP Address : "; $message .= $_SERVER['REMOTE_ADDR']; $message .= $eol; foreach ($_POST as $key => $value) { if (!in_array(strtolower($key), $internalfields)) { if (is_array($value)) { $message .= ucwords(str_replace("_", " ", $key)) . " : " . implode(",", $value) . $eol; } else { $message .= ucwords(str_replace("_", " ", $key)) . " : " . $value . $eol; } } } $body = 'This is a multi-part message in MIME format.'.$eol.$eol; $body .= '--'.$boundary.$eol; $body .= 'Content-Type: text/plain; charset=UTF-8'.$eol; $body .= 'Content-Transfer-Encoding: 8bit'.$eol; $body .= $eol.stripslashes($message).$eol; if (!empty($_FILES)) { foreach ($_FILES as $key => $value) { if ($_FILES[$key]['error'] == 0) { $body .= '--'.$boundary.$eol; $body .= 'Content-Type: '.$_FILES[$key]['type'].'; name='.$_FILES[$key]['name'].$eol; $body .= 'Content-Transfer-Encoding: base64'.$eol; $body .= 'Content-Disposition: attachment; filename='.$_FILES[$key]['name'].$eol; $body .= $eol.chunk_split(base64_encode(file_get_contents($_FILES[$key]['tmp_name']))).$eol; } } } $body .= '--'.$boundary.'--'.$eol; if ($mailto != '') { mail($mailto, $subject, $body, $header); } header('Location: '.$success_url); } catch (Exception $e) { $errorcode = file_get_contents($error_url); $replace = "##error##"; $errorcode = str_replace($replace, $e->getMessage(), $errorcode); echo $errorcode; } exit; } ?> Pilates Class Booking

PILATES CLASS BOOKING

CLASS BOOKING & HEALTH QUESTIONNAIRE
Before you continue with this Class Booking you should review our
Terms of Booking
Day?
Time?
Has your doctor said you have a heart condition and you should only do physical activity recommended by a doctor?
Do you ever feel pain in your chest when you do physical activity?
Have you ever had chest pain when you are not doing physical activity?
Do you ever feel faint or have spells of dizziness?
Do you have a joint problem that could be made worse by exercise?
Have you ever been told you have high blood pressure?
Are you currently taking any medication which we should be made aware?
Are you pregnant or have you had a baby in the last 6 months?
Is there any reason you should not participate in physical activity?
Do you suffer from any condition such as epilepsy or diabetes that we should be made aware of?
This form collects personal information. Check out our Privacy Policy to read how we protect and manage your submitted data.
I have read and agree the Terms of Booking
I consent to Purely Pilates collecting the information on this form to process my booking.
I consent to Purely Pilates contacting me by email to provide updates on what is going on at our studio.
To complete your booking you must also pay for the class (if you have not already paid). Please submit this form then return to the class timetable and use the Pay Now button for the class you are booking.