Welcome, New Student!Let us know a bit about yourself by filling out this form. Name * First Name Last Name Phone * (###) ### #### Sign Up to Receive Texts By providing your mobile number and opting in, you consent to receive SMS or MMS messages from Pike & Plank Pilates, a SpiritOak, Inc. company, regarding class schedules, promotions and updates. Message and data rates may apply. Message frequency varies. Consent is not a condition of purchase. We respect your privacy—your information will be handled in accordance with our Privacy Policy. Reply HELP for more info. You can opt out at any time by replying STOP to cancel. After opting out, you will receive a confirmation message, and no further messages will be sent unless you opt in again. To exercise your rights under the California Consumer Privacy Act (CCPA), reply PRIVACY or contact us at 925-300-3610 or hello@pikeandplank.com. For assistance, reply HELP. Opt in Opt out Best Time to Reach Email * Date of Birth * MM DD YYYY Interest * Duet Private Classes Group Classes Combination Please explain any prior experience with Pilates: Medical History Do you have any of the following conditions? Please select all that apply to your medical history Bulging or herniated disk(s) Joint replacement Spinal fusion History of heart attack or stroke Osteoporosis Significant undiagnosed pain Please explain any other active injuries or medical conditions: Women Only Are you pregnant? Yes No Have you given birth within the past 6 months? Yes No If "Yes" to either of the above, has your doctor cleared you for exercise at this time? Yes No How many weeks pregnant or postpartum are you? What exercise, if any, have you been doing? Availability Please select all times you are available Monday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Sunday Morning Evening Thank you!