Enrollment Application

Thank you for your interest in our Equilibrium Pilates certification courses. We kindly request that all prospective students complete our application/registration form so that we may learn a bit more about you to best help you meet your training goals.

If you'd like to apply for a course with us, you may use our online form below, or you can download the form as a Word document to fax to our head office.

Should you simply have a question about our courses please email us and one of our staff will be happy to answer your questions and then assist you with registration.


SECTION A: PERSONAL DETAILS
Name:
Postal Address:
Physical Address:
Telephone:
Cell:
Fax:
Email:
Date of birth:
Citizenship:
ID no.:
Occupation:
First language:
Other languages:



SECTION B: INTERNATIONAL APPLICANTS
Passport number
Nature of visa:
Social Security number:
Telephone:
Fax:
Email:
Do you require assistance in finding accommodation in Cape Town for the period of your studies?
Do you wish to be met at the airport? (See airport transfer fees):


SECTION C: NEXT OF KIN
Name:
Relationship:
Address:
Telephone:
Cell:
Fax:
Email:


SECTION D: EDUCATION
Highest educational qualification:
Graduation year:
Institution where you achieved this qualification
Indicate any other subjects that you have studied that are related to Basic Health and Fitness Science:
NB: A recognised qualification in Exercise and Fitness Studies (or Exercise Science) is required for entrance to any Equilibrium Pilates Systems course unit. Equilibrium Pilates Systems can help you to achieve the necessary qualification. Please ask us for details.



SECTION E: MOVEMENT HISTORY
(In the scales below 1 indicates a poor rating and 5 indicates an excellent rating)


Own assessment of your body awareness

1 2 3 4 5

Own assessment of your general flexibility

1 2 3 4 5

Own assessment of your general body strength

1 2 3 4 5

Own assessment of your cardiovascular health related fitness

1 2 3 4 5

Own assessment of your overall health and wellness

1 2 3 4 5

Have you ever done any exercise based on The Pilates Method?
Please describe your previous exposure to Pilates:

Name any other sports/dance/physical activities that you have participated in:

How many times a week do you exercise now?

Do you have any injuries that affect your ability to move or exercise?
(Please provide details that will help us modify your training if it is necessary to do so).

How have you managed injuries in the past?

Do you have any other health challenges?

Are you using any medication (prescription or other)?
Please list them.

Do you use any mind-body techniques to maintain health or deal with
ill-health? (like yoga, meditation etc.)



SECTION F: COURSES

Please select the course(s) you are interested in
Orientation
Mat Level 1
Mat Level 2
Mat Level 3
Reformer Level 1
Reformer Level 2
Reformer Level 3
Trapeze Table Level 1
Trapeze Table Level 2
Chair Level 1
Chair Level 2
Accessories Level 1
Accessories Level 2
Barrels Level 1
Workshops

I declare that the information provided by me in the above questionnaire is truthful and correct.



All equipment prices exclude sales tax. | ©Equilibrium 2005
Tel: +27 21 433 1880/2/3/4 Email: sales@equilibrium.co.za More...