DD slash MM slash YYYY
Please pick the option below that matches your occupation best.
Unlicensed meaning not affiliated to a boxing organisation.
Shipston Personal Training LTD, Marc Edwards and Representatives means anybody delivering a training session / Course / Workshop in association with / on behalf of Marc Edwards or Associated Training Provider, including (but not limited to) any of the following names:
Marc Edwards / Marc Edwards Fitness / K5 Health and Fitness / Universal Training Academy / Universal Training / Universal Fitness Training / Universal Martial Arts Training / Universal Personal Training / K500 Kickboxing / PTSOS / Shipston Personal Training / WAKO GB
I am aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, I am voluntarily participating in a physical activity.
Having such knowledge, I hereby acknowledge this release, any representatives, agents and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.
Covid 19 Consent Form
I understand that the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which the carriers of the virus may not show not show the symptoms and may still be contagious.
I understand that physical distancing of 2 meters may not be possible while in the Studio.
Hard surfaces such as door handles, Ipads, payment terminals and all training equipment will be sanitised and wiped prior and after use.
I confirm that I am not currently positive for novel coronavirus.
I confirm that I am not waiting for the results of a laboratory test for the novel coronavirus.
I verify that I have not returned to the UK from any country outside of the UK, whether by car, air, bus or train in the past 14 days.
I verify that I have not been identified as a contact of someone who has test positive for the novel coronavirus or been asked to self-isolate by The Department of Health, or any other government agency.
I confirm that I am not presenting with any of the following symptoms of COVID-19 identified by the CDC
Fever > 38C, or 100F, chills or body aches
Shortness of breath
Loss of smell or taste
I understand that I may be unable to proceed with services with PTSOS if they are deemed unsafe to myself. I understand Shipston Personal Training & Representatives will do everything possible to minimize the spread of COVID – 19, but will not hold them responsible should I contract the COVID – 19.
I will immediately notify the trainer if I contract the virus within two weeks following my visit.
Demands and Needs statement
The Sports Accident Insurance policy meets the demands and needs of an active person who wishes to be covered by a Sports Accident policy whilst participating in sports/leisure activities that are named within the Sports Group(s) chosen, for the duration specified, and for the level of benefits requested. It is in no way a substitute for Travel Insurance, and should not be relied upon to cover Medical Expenses abroad, or Repatriation.
This field is for validation purposes and should be left unchanged.