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Member Registration
Kindly fill in the registration form as per requested
PERSONAL DETAIL
Complete Name
Gender Male Female
Date Of Birth
Age   years old
Phone Number
Handphone
Office
Home
Email Address
Home Address
Office Address
Postal Address
Marital Status Married Single
Number Of Kids None Yes   Kid(s)
Occupation Not Working Working
Company Name
Citizens Indonesia Expatriate
Are you new to Yoga/Pilates Yes No
How long experience you have in Yoga/Pilates?
Yoga   Months   Years
Pilates   Months   Years

HEALTH PROFILE
Are you pregnant No Yes   Week(s)
Condition requiring medical attention,
I have a:
Stroke High Blood Presure
Diabetic Low Blood Presure
Hyperthyroidism Hypothyroidism
Other conditions not listed above, please state:
Injury causing from sports, accidents, bad posture,
I have a:
Frozen Shoulders Weak Knees
Hip Problems Back Problems
Tennis Elbow(s) Ankle Injury
Scoliosis Wrist Injury
Other conditions not listed above, please state:

TERMS AND CONDITIONS
  1. Fill up the member registration form with 3 x 4 cm photo size and an ID card copy for issuing a card member
  2. The card member costs are Rp 50.000,- /person /year
  3. The membership card and package that paid, used or not are not transferable to anyone with any reason
  4. The membership card is not transferable and has to be submitted to the reception for joining the practices
  5. In the case of extension of membership, The extension fee is Rp. 50,000,- /person /year, and should be pay two weeks before member valid date is expired
  6. In the case of losing a card, an administration fee of Rp. 50.000,- will be charged for a replacement
  7. The Yoga and Pilates packages are not refundable if totally unused or partial used
  8. The Special Prenatal packages are for pregnancy over than 20 weeks, and required doctor`s reference
  9. Private Session Machine Pilates:
    a. One instructor for one person
    b. Free 2x changes date of appointment for valid membership card
    c. Canceling at least 24 hours before session start. If not 50% of coming costs will be charged
  10. The programs at Java Yoga & Pilates Centre are training programs just for a member that need a regular training, and not the particular training or a learning program for instructors or candidate instructors from outside of Java Yoga & Pilates Centre.
  11. For protecting of Java Yoga & Pilates Centre work interest, safety and also consideration of another members, Java Yoga & Pilates Centre have the right to terminate the membership of every member. Any reason of these including bad behaviour (steal, disturb another members, make a noisy condition in training studio), profit monetary (to carry on trade in training studio), and the behaviour that break the term and conditions due in this agreement or rules that placed against training studio. The management also don`t have the right to refund the membership fee.
I have read and understood the content of terms and conditions listed above

DISCIPLINES AND RESPONSIBILITIES:
  1. Cellular Phone should be non-actived during practices
  2. The member should bring locks for keeping personal items in lockers
  3. The Management does not take responsibilities of lost / stolen valuables in the area of Java Yoga and Pilates Centre
  4. The Management does not take responsibilities of injured / accident in the area of Java Yoga and Pilates Centre
  5. The Management does not take responsibilities if the member forgot their Yoga or Pilates member valid date and the remainder of member valid cannot be used. The management just helped reminding the member before member valid date is expired.
I have read and understood the content of disciplines and responsibilities listed above

ID Card Copy
Maximum Image Size for Scan Image ID Card is 343 x 217 pixels
with image resolution 100 dpi.
Allowed image types .jpg, .png
Self-Photo
Maximum Image Size for Image Photo is 85 x 113 pixels (Equals with 3 x 4 cm)
with image resolution 100 dpi.
Allowed image types .jpg, .png

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