Address*

Name*

Date of Birth*

Phone No*

Email Address*

Experience

Profile*

(Please include details of whether you attend Pilates Classes, whether you are a certified fitness / movement instructor, rehabilitation professional; number of years, etc.)

Details of any Physical Disability or Impairment*

Details of any Learning Disability or Impairment*

Details of any Allergies or Intolerances*

Do you need help with Travel / Accommodation*

Emergency Contact Name & Phone Number*

I have read and agree terms of booking*

The specific course & dates you are booking. Please select from the drop-down list*

I consent to having Purely Pilates collect the information requested on this form to book me on a course*

Purely Pilates provide teacher training as an agent of Balanced Body Inc, a USA based business. We are required to pass details of student teachers to Balanced Body.

This form collects personal information. Check out our Privacy Policy to read how we protect and manage your submitted data.

I consent to an international transfer of the information on this form, from Purely Pilates to Balanced Body Inc*