Pilates Reformer Registration Packet
Rice University | Barbara and David Gibbs Recreation and Wellness Center recreation.rice.edu |
[email protected] | 713.348.4058
Table of Contents Introduction............................................................................................................................................ 1 Barbara and David Gibbs Recreation and Wellness Center Mission ........................................... 1 Pilates Reformer ................................................................................................................................... 2 What is Pilates? ................................................................................................................................ 2 What is the Pilates Reformer? ......................................................................................................... 2 What happens during a typical private Reformer session? ........................................................... 2 Is the Reformer well suited for all fitness levels and ages? .......................................................... 2 What are the benefits of incorporating reformer sessions into your regimen? ............................ 3 What can a personal Pilates instructor do for you ......................................................................... 3 How to get started ............................................................................................................................. 3 Packages and Pricing ....................................................................................................................... 4 Pilates Reformer Policies & Agreement.............................................................................................. 4 Participation Agreement and Assumption of Risks and Liability ................................................... 6 General Information .......................................................................................................................... 7 Package ............................................................................................................................................. 8 Training Availability ........................................................................................................................... 8 Physical Activity Screening Questions ............................................................................................ 9 General Health History Questions ................................................................................................. 10 Medical /Health History .................................................................................................................. 11 Weight History ................................................................................................................................. 12 Physical Activity/Exercise History .................................................................................................. 12
Barbara and David Gibbs Recreation and Wellness Center Pilates Reformer Registration Packet
Introduction Barbara and David Gibbs Recreation and Wellness Center Mission The mission of the Barbara and David Gibbs Recreation and Wellness Center is to encourage a lifetime of health and wellness for the students, faculty, and staff of Rice University by promoting the physical, social, intellectual and emotional benefits of physical activity. To that end a wide array of recreational programs and services has been created and are offered in an effort to increase knowledge about and provide opportunities for the development of healthy behavior patterns.
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Pilates Reformer What is Pilates? Joseph Pilates developed the Pilates (Pronounced: pee-la-tees) technique of body conditioning over 80 years ago. It has long been a method employed by dancers and athletes to prevent muscular imbalances and to maintain proper skeletal alignment.
What is the Pilates Reformer? The principle apparatus used in Pilates technique is known as the "Reformer”. The Reformer is a carefully crafted piece of equipment consisting of a horizontal platform with a moveable carriage that is controlled by adjustable springs. The springs allow for variable resistance during the exercises according to an individual's capabilities and needs.
What happens during a typical private Reformer session? During a Reformer session, the instructor will assist the client in a series of exercises performed in various positions including sitting, standing, reclining on one's back and even in a prone position on one's stomach. During certain exercises, the attached straps are either held in the hands or placed over the feet, thereby expanding the opportunity to work several parts of the body simultaneously. This not only improves coordination but also assists in the proper alignment of the body during movement.
Is the Reformer well suited for all fitness levels and ages? Pilates Reformer exercises can be done by anyone irrespective of age and fitness level. If you have normal health, these exercises strengthen your trunk, pelvis and shoulder girdle. It improves breathing patterns, corrects spinal and pelvic alignment. It streamlines the control over movements of the body.
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What are the benefits of incorporating reformer sessions into your regimen?
Develops core or deep abdominal muscles along with those muscles that are closest to the spine, making individuals more agile.
Improves posture, allowing the body to function without stress and pain.
Helps prevent injury through proper mind-body coordination.
Large, more bulky muscle mass may become leaner and better defined, while smaller intrinsic muscles become stronger giving one a fine conditioned, balanced body and improved fitness level.
Helps reduce lactic acid build up by emphasizing a strong supported center body, correct alignment, and a precise breathing pattern. In turn, this greatly reduces soreness during or after a session.
What can a personal Pilates instructor do for you?
Act as a motivator to help you reach your individual fitness goals.
Provide encouragement, support and recognize your strengths and challenges.
Identify barriers and suggest solutions to get you on the road of becoming healthier and happier!
How to get started?
Complete the Pilates Reformer Registration Packet.
Return the packet to the Gibbs Recreation and Wellness Center Administrative Office, or send via campus mail to the Assistant Director for Fitness Programs
Submit payment online at recreation.rice.edu/fitness/pilates
The Instructor will contact you within 48-72 hours to schedule an appointment.
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Packages and Pricing Individual Packages Session Type Students Non-Student Member
Services
Package 1
$135
$155
Includes 30-minute consultation and three 60-minute private sessions.
Package 2
$215
$245
Includes 30-minute consultation and five 60-minute private sessions.
Package 3
$400
$445
Includes 30-minute consultation and ten 60-minute private sessions.
Package 4
$755
$825
Includes 30-minute consultation and twenty 60-minute private sessions
**Sessions, orientations, fitness assessments, and packages purchased prior to June 30, 2012 must be used by July 1, 2012 or the remaining balance will be forfeited.
Pilates Reformer Policies & Agreement By initialing next to each directive below and signing this policy review, you are indicating that you have read, understood and will abide by the policies stated. Initial _____ Payment Policy Sessions will be prepaid and payment is due at the time of initial appointment. The only accepted form of payment is through the Barbara and David Gibbs Recreation and Wellness Center Website (recreation.rice.edu/fitness/pilates). Paying a instructor directly is strictly prohibited. _____ Session Duration Consultations are approximately 30 minutes in length. Pilates Reformer sessions are 60 minutes in length. _____ Risk Factor Notice Clients must be cleared of any risk factors associated with physical activity prior to meeting with an instructor for a session. If a client is identified as high risk, the client
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must provide the instructor with a signed physician’s medical release form stating that the client has been cleared to engage in physical activity. _____ Training Facility The Gibbs Recreation and Wellness Center will be the training facility for Pilates Reformer services during the time of appointment. Instructors are not allowed to train under any other conditions or circumstances. _____ Refund Policy Pilates Reformer packages are non-refundable. _____ Transfer Policy All Pilates Reformer sessions are non-transferable. All Pilates Reformer packages must be paid in full and submitted to the Gibbs Recreation and Wellness Center Administrative Office or via campus mail to the Assistant Director for Fitness
Programs before the first session of each package is conducted. Sessions within a package cannot be split or transferred amongst other individuals such as spouses, peers, children and friends. _____ Late Policy Pilates Reformer clients are responsible for arriving in a timely manner to their sessions. The instructor is required by policy to wait 15 minutes beyond the scheduled start time before the session is forfeited. If a client's session begins late due to the client's late arrival, the instructor will continue with the session and end at the scheduled time. _____ Cancellation Policy Except in the event of an emergency, a minimum of 24 hours notice is required for the cancellation of a Pilates Reformer session. Failure to cancel within 24 hours or failure to show up for a session will result in a forfeit of the session. Exceptions will only be made in the case of a medical emergency accompanied by a doctor’s note. If there should be a discrepancy, the decision will be determined by the Assistant Director for Fitness Programs. Pilates Reformer clients should contact their instructor directly should they Barbara and David Gibbs Recreation and Wellness Center Pilates Reformer Registration Packet
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need to cancel. If a client is unable to reach their instructor, they may contact the Assistant Director for Fitness at 713-348-5765. _____ Expiration of Pilates Reformer Sessions All sessions, packages and consultations purchased prior to June 30, 2012 expire July 1, 2012. I have read and understand the policies and procedures stated above. Signature of Participant
Printed Name of Participant
Date Signed
___________________
______________________
_________
Participation Agreement and Assumption of Risks and Liability I,_____________________________________, desire to participate in the activities and programs of the Rice University Barbara and David Gibbs Recreation and Wellness Center (the “Activities”) and, in consideration of being allowed to participate in the Activities and to use the machinery and equipment of the Barbara and David Gibbs Recreation and Wellness Center (the “Facilities”), I do hereby acknowledge and agree as follows: 1. I am fully informed and aware that my participation in the Activities and use of the Facilities involve certain risks, including, but not limited to, property damage and loss, bodily injury, illness and even death. I fully assume any and all risks. 2. I am in sufficient physical and mental health to participate in the Activities and to use the Facilities. I have medical insurance coverage appropriate for my participation in the Activities and use of the facilities, and I have provided medical insurance and emergency contact information below my signature on this agreement. I understand that Rice University shall not provide any insurance for me in connection with my participation in the Activities or use of the Facilities. 3. I fully and forever release, waive and discharge, and covenant not to sue Rice University (including but not limited to, its trustees, faculty, staff, students, agents and representatives), from and for any and all demands, claims , actions, suits, damages, losses, liabilities, costs and expenses (including, but not limited to, court costs and attorneys’ fees), from any cause
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whatsoever (including, but not limited to, property damage or loss, bodily injury, illness or death) directly or indirectly arising in connection with my participation in the Activities or use of the Facilities, whether or not foreseen or contributed to by the negligent acts or omissions of Rice University or others. 4. This Agreement constitutes the entire agreement, and supersedes any prior or contemporaneous agreements, regarding this subject matter. The Agreement (i) may not be amended, by course of conduct or otherwise, and (ii) may not be assigned, in whole or part, except in writing duly executed by Rice University. This Agreement shall be interpreted and enforced in accordance with the laws of the State of Texas, without regard to any conflicts or choice of law principles, and shall be as broad and inclusive as permitted by such laws. If any provision of this agreement is held unenforceable by a court, such unenforceability shall not affect any other provision, and this Agreement shall be construed as if such provision, to the extent of such unenforceability, had not been incorporated herein. 5. I (i) have read and fully understand this Agreement, (ii) intend that this agreement be legally binding upon and enforceable against me and my family, estate, heirs, and legal representatives, (iii) intend that this agreement benefit Rice University, (iv) confirm that I am at least 18 years of age, fully competent, and am entering into this Agreement voluntarily and of my own judgment. I have duly executed and delivered this Agreement as of___________, 20_______. Signature: ___________________________Medical Insurance Co.:____________________ Print Name: ______________________________Medical Insurance #.:________________ Emergency Contact Name: _________________________Phone.:__________________
General Information Name: __________________________ Membership ID#: _______________ Date: _________ Membership Status: Student___
Faculty___
Staff___
Alumni ___
Mailing Address: ______________________________________________________________________
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Email Address: ____________________________ Date of Birth: _________Age: ________ Phone number (C): ________________________ Phone (H): _________________________ Primary Care Physician: _________________________________________________________________ Physician’s Phone Number: ______________________________________________________________ Physician’s Address: ___________________________________________________________________ Regular physical activity is enjoyable and healthy, and for most people safe. However some individuals may have health related risks that might require them to check with their physician prior to starting an exercise program. To help determine if there is a need for you to see your physician before starting an exercise program, carefully read and answer the following questions. All information will be kept confidential.
Package Please indicate the package you choose by placing a check mark next to it. Package 1 ____
Package 2 ____
Package 3 ____
Session Type Students Non-Student Member
Package 4 ____
Services
Package 1
$135
$155
Includes 30-minute consultation and three 60-minute private sessions.
Package 2
$215
$245
Includes 30-minute consultation and five 60-minute private sessions.
Package 3
$400
$445
Includes 30-minute consultation and ten 60-minute private sessions.
Package 4
$755
$825
Includes 30-minute consultation and twenty 60-minute private sessions
Training Availability Please list the times for each day you are available to train. Be specific by including specific hours and times frames. Monday:
_______________________________
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Tuesday:
_______________________________
Wednesday: _______________________________ Thursday:
_______________________________
Friday:
________________________________
Saturday:
________________________________
Sunday:
________________________________
Physical Activity Screening Questions (Please answer yes or no to the following questions) ___ YES ___NO 1. Has your physician ever told you that you have a heart condition? ___ YES ___NO 2. Do you experience chest pain when you are physically active? ___ YES ___NO 3. In the past month, have you experienced chest pain without performing physical activity? ___ YES ___NO 4. Do you lose balance because of dizziness or do you ever lose consciousness? ___ YES ___NO 5. Do you have a bone/joint problem that could be aggravated by a change in your level of physical activity? ___ YES ___NO 6. Is your physician currently prescribing medication for your blood pressure or heart condition? ___ YES ___NO 7. Are you a male over the age of 45? ___ YES ___NO 8. Are you a female over the age of 55? ___ YES ___NO 9. Do you know of any reason why you should not participate in a program of physical activity?
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If you answered yes to any of the questions above, it is recommended that you consult with your physician by phone or in person before having a fitness test or participating in a physical activity program.
General Health History Questions (Please answer yes or no to the following questions) ___ YES ___NO
1. Have you ever had a stroke?
___ YES ___NO
2. Do you have diabetes? If yes, are you currently taking any medications? _____________________________
___ YES ___NO 3. Do you have asthma or another respiratory condition that causes difficulty breathing? If yes, please explain: _________________________________________ ___ YES ___NO 4. Do you have an orthopedic condition that would restrict you in performing physical activity? If yes, please explain: __________________________________________ ___ YES ___NO 5. Have you ever been told by a physician that you have one of the following. (Check all that apply) ____ High Blood Pressure ____ Elevated blood lipids, including elevated cholesterol ____ Cardiovascular disease ____ Cancer ____ Other health/medical condition (Please describe): _________________________________________________________________ ___ YES ___NO
6. Do you currently smoke or have you smoked in the past and stopped within the past six months?
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___ YES ___NO
7. Do you currently have back pain or have you had back pain within the past six months or felt discomfort that prevented you from carrying out normal daily activities?
___ YES ___NO
8. Are you pregnant?
If you answered yes to any of the questions above, it is recommended that you consult with your physician by phone or in person before having a fitness test or participating in a physical activity program. In some instances, you may be required to obtain a physician’s written clearance before an exercise program can be designed for you.
Medical /Health History (Please answer yes or no to the following question) ___ YES ___NO
Are you currently taking any medication regularly, including any
supplements, vitamins, minerals, homeopathic remedies, birth control or over-the-counter drugs? If yes, list the type and purpose. Type: ____________________________________________________________ Purpose: _________________________________________________________ Type: ____________________________________________________________ Purpose: _________________________________________________________ Type: ____________________________________________________________ Purpose: _________________________________________________________ Type: ____________________________________________________________ Purpose: _________________________________________________________ List any allergies that you have. ____________________________________________________________________________ ____________________________________________________________________________ __________________ Barbara and David Gibbs Recreation and Wellness Center Pilates Reformer Registration Packet
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Weight History Height: ______ Current Weight: _____ How long have you been at this weight? ____________________ Do you wish to ____ gain or _____ lose weight? If so, how much? _____________
Physical Activity/Exercise History What time of day do you typically work out? ____________________________________________________________________________ Please describe your current lifting routine (including days of the week, exercises, weights, reps, sets, rest periods, intensity, etc). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________ Please describe your current cardio training program (including type, time, frequency, intensity, etc). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________ Please provide any other additional details that would help with training: __________________________________________________________________________
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