The Studio Derry

Parental Consent &
Health Screening Waiver

Reformer Pilates · Participant Under 18

Please complete this form before your child's first class. Your details go straight to our team so we have consent, health screening and emergency contacts on file. You'll get a confirmation email once submitted. If you flag any health issues or opt out of photo/video, please also mention it to your instructor at the start of the first class.

Waiver received

Thanks. Your parental consent is now on file with our team.

🩺 One quick reminder

If you flagged any health issues or opted out of photo / video, please mention it to your instructor at the start of the first class — it takes 30 seconds and helps us tailor the session safely.

A confirmation has been emailed to you. Your child is cleared to attend classes.

Questions? Email thestudiolderry@gmail.com.

1 · Participant Details

Who is attending?

Details of the child (participant) and the parent/guardian giving consent.

2 · Health Screening

Anything we should know?

Please answer each question about the participant. If you answer Yes to any question, add details below.

1.Does the participant have any medical condition(s) that may be affected by exercise?
2.Has the participant had any surgery or significant injury in the past 12 months?
3.Does the participant suffer from any joint, bone, or muscle problems (e.g. scoliosis, hypermobility)?
4.Does the participant have asthma, epilepsy, diabetes, or any heart condition?
5.Is the participant currently taking any medication?
6.Does the participant have any allergies we should be aware of?
7.Is there any other reason the participant may need modified or restricted exercise?
3 · Assumption of Risk & Liability Waiver

Please read carefully

I, the undersigned parent/guardian, acknowledge and agree to the following on behalf of the above-named participant:

(a)I understand that Reformer Pilates involves physical exercise using spring-loaded resistance equipment, and that participation carries an inherent risk of injury.

(b)I confirm that, to the best of my knowledge, the participant is in good health and physically able to take part in Reformer Pilates classes. I have disclosed all relevant medical information above.

(c)I understand that The Studio Derry and its instructors are not medical professionals. If the participant has any medical condition or concern, I will obtain clearance from a qualified medical practitioner before the participant attends class.

(d)I agree that The Studio Derry, its owners, employees, and instructors shall not be held liable for any injury, loss, or damage arising from the participant's attendance, except where caused by proven negligence on the part of The Studio Derry.

(e)I agree that the participant will follow all instructions given by the instructor and will inform the instructor immediately if they feel unwell, experience pain, or are unsure how to use any equipment.

(f)I understand that I may be asked to remain on the premises during the class, or to be contactable by phone at all times while the participant is attending.

4 · Photo & Video Consent (optional)

Marketing use

I give permission for photographs or videos taken during classes to be used by The Studio Derry for marketing and social media purposes. I understand I can withdraw this consent at any time by notifying the studio in writing.

Photo / Video Consent
5 · Declaration & Signature

Sign to confirm

I confirm that the information provided above is accurate and complete. I consent to the above-named participant taking part in Reformer Pilates classes at The Studio Derry, and I accept the terms outlined in this waiver.

Typing your name above constitutes a valid electronic signature under UK law (Electronic Communications Act 2000).

By submitting, you agree we may store this waiver securely and process it in accordance with data-protection legislation.