Pilates Reformer Certification Course Application

Mail your application to:

Smart Workout 124 East 40^th Street, Room 603, New York, NY 10016 or Fax: 212-661-1880

Contact Information please print

Name:

_____________________________________________________________________________________________________________________

Address:

_____________________________________________________________________________________________________________________

City: prov. / state: country: postal / zip code:

_____________________________________________________________________________________________________________________

Business phone: Home phone: Cell:

_____________________________________________________________________________________________________________________

E-mail

_____________________________________________________________________________________________________________________

Course Registration

Applications must be accompanied by a detailed resume / CV outlining relevant education and experience, two letters

of references, and a $400 deposit. Our courses are limited to a maximum of ten people, and applications will be

processed on a first-come-first-served basis.

Space will ONLY be reserved upon the receipt of all application materials and deposit.

Fees for courses do not include required course materials or applicable exam fees. Course fees are due two weeks

before course start date. Deposits and course fees, with limited exception, are non-refundable, and non-transferable.

Check our website for full details on our refund and cancellation policies.

Start Date Requested

_____________________________________________________________________________________________________________________

Payment Method

□ deposit only □ full payment □ MasterCard □ VISA □ AMEX □ check □ money order

_____________________________________________________________________________________________________________________

account number: exp:

_____________________________________________________________________________________________________________________

name on card: signature:

_____________________________________________________________________________________________________________________

Reference Letters

Letters should reflect course prerequisites, your teaching abilities and character

_____________________________________________________________________________________________________________________

Relevant Education

Please list related degrees, diplomas, postsecondary or certificate courses and workshops

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Describe anatomy education: Include number of hours, when / where you studies and what topics were covered
(e.g. musculoskeletal, anatomy, biomechanics) □ college / university course □ workshop / other

List related certification (please specify: e.g. ACE, AFAA)

Relevant Experience

Outline your teaching experience (describe subject taught / years teaching)

Describe your personal experience in dance, yoga, fitness or other body work (how many years / how recently)

Outline your pilates experience (describe who you’ve studied with, when, & where, and for how long)

Indicate Smart Workout, or other. □ none □ 1-10 hrs □ 10-30 hrs □ 30+ hrs

Personal Information

Do you have any injuries, (including current or recent pregnancy) or postural issues?

Failure to disclose any injuries, conditions or postural issues prior to enrollment may result in your removal from the course or
the modification of course repertoire for you individually. Please note that we cannot accept applicants who are currently pregnant.

How did you hear about Smart Workout and its education program?

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

What are your personal goals which this program could help you achieve? Are you interested in becoming a
pilates instructor? If so, why?

Are you using this course to fulfill continuing education credits? □ Yes □ No If so, for what organization?

Are you applying for the workshop-only portion of our program? □ Yes □ No

Are you applying for full certification? □ Yes □ No

I hereby certify that the information provided on this application is accurate.

I understand that failure to provide accurate information may result in my removal from the certification program.

I have included the following:

□ $400 course fee deposit

□ Two letters of reference

□ Detailed resume / CV of education / experience

Applications that do not include the above will not be processed

Signature: date:

_____________________________________________________________________________________________________________________