Federica Catino | Client Information

First name *

Last name *

Address *

Postal code/City *

Email address *

Phone *

Date of birth *

Profession

First name *

Last name *

Relationship

Phone *

How did you hear about us? *

Internet/Website
Flyer
Social Media
Reccomendation

storage Phone First

Please specify *

What are your main goals for this course? (e.g., posture, strength, rehabilitation, stress relief, other) *

Do you have Pilates experience? *

How long? *

Are you doing sport regularly? *

Which one? *

Do you have any current or past medical conditions, injuries, or surgeries that may affect your ability to exercise? *

Please specify *

Are you currently under medical treatment or taking medication? *

Please specify *

Do you have any physical limitations or chronic pain? *

Please specify *

Additional information that the trainer should know about your physical condition

Federica Catino will collect the personal data provided, including health information, solely for the purpose of ensuring safe and
personalized Pilates training.
All data will be treated confidentially and stored securely.
Health information will not be shared with third parties without the client’s explicit consent, except when required by law.
The client may request access to, correction of, or deletion of their data at any time.

Personal data storage *

I consent to the storage and processing of my personal and health data for the duration of my participation in Pilates lessons, and for up to 5 years after the last session, unless a longer retention period is required by law.

Health insurance *

I consent to my data being used to issue participation confirmations to my health insurance, if requested.

Truthfulness personal data *

I confirm that the my date and information provided are true and complete. I will inform the trainer of any changes in my health status. I understand that participation in Pilates lessons is at my own risk and that the trainer cannot be held liable for injuries, except in cases of gross negligence or intent.

Date *

Signature *

Clear Signature