Please complete this feedback and summary form below. We care a whole bunch about your thoughts and feedback, please be honest. That’s the only way we can keep improving.

Thank you!

 
                

                        

                            
Sweat-Box Studio Application Form
                            
                        

                        


Sweat-Box PT Studio
Membership Application Form
Please complete all fields below as accurately and honestly as possible

Name*

                            
                                                    
                                                    First
                                               
                            
                                                    
                                                    Last
                                                
                            

                        
Address*    
                    

                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State / Province / Region
                                      
                                    
                                    ZIP / Postal Code
                                
                                        AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands
                                        Country
                                    
                    

                
Phone*
Email*

                            
                        
Date of Birth*

                            
                            DD slash MM slash YYYY
                        
                        
Next of Kin Name*
 
Next of Kin Contact Number*
 
Doctor Name*
 
Doctor Surgery / Contact*
 
Do you suffer / Have you suffered from any of the following?

								
								Rheumatoid or Osteo Arthritis
							

								
								Head / Neck Injury
							

								
								Shoulder/Arm/Wrist/Hand Injury
							

								
								Back Pain / Injury
							

								
								Hip / Pelvis Injury
							
Do you suffer / Have you suffered from any of the following?

								
								Knee / Thigh / Leg Injury
							

								
								Ankle / Foot Injury
							

								
								Nerve Damage
							

								
								Swollen Joints
							

								
								Fractured Bones
							
Do you suffer / Have you suffered from any of the following?

								
								Heart Problems
							

								
								Diabetes
							

								
								Epilepsy
							

								
								Early menopause
							

								
								Cancer
							
If You answered yes above, please provide details
Are you currently recieving treatment for anything?

			

				
				Yes
			
			

				
				No
			
Have you had major surgery in the last 10 years?

			

				
				Yes
			
			

				
				No
			
Have you had minor surgery in the last 2 years?

			

				
				Yes
			
			

				
				No
			
If you answered yes to the above, please provide details
Do you suffer / have you suffered OR have you ever had a medical consultation for any of the following conditions?
AsthmaEpilepsyHigh / Low Blood PressureHeart Conditions / ProblemsChest Pains
If You answered yes above, please provide details
Any other health issues not already mentioned, please list here:
Are you pregnant?

			

				
				Yes
			
			

				
				No
			
Membership Options

There are a few membership options. Individual, Couple and both of those with PT included.
Individual is pretty much what you'd expect. You pay for access for 1 person to train. Couple is for 2 people to train and if you opt for an Individual PT membership this is for 1 person to train whenever they want but with a PT session (or 4) included to boost productivity and chances of reaching goals. Same for the couples. Not rocket science :-) 
Which membership type are you applying for?*

			

				
				Individual
			
			

				
				Individual with PT - Monthly
			
			

				
				Individual with PT - Weekly
			
			

				
				Couple
			
			

				
				Couple with PT - Weekly
			
			

				
				Couple with PT - Monthly
			
Have you ever been diagnosed with a learning disability / have any problems learning in school / require any special provision for assessments because of learning issues?*

			

				
				Yes
			
			

				
				No
			
I understand that certain elements of the Session/Course can be physically demanding. I accept full & complete responsibility for my participation in the practical elements of this session/course*

			

				
				Yes
			
I agree that Marc Edwards Fitness & Representatives' are free of any/all liability for death, injury or health problem that may result from/be aggravated by my participation*

			

				
				Yes
			
I agree that Marc Edwards Fitness & Representatives' are free of any/all liability for death, injury or health problem that may result from/be aggravated by this training with 3rd parties*

			

				
				Yes
			
I understand that by signing this / completing this form that any use of excersises post course/workshop/session, I assume all responsibility for demonstrations and the safety of the end user, even if the end user is myself*

			

				
				Yes
			
Marc Edwards Fitness and Representatives means anybody delivering a training session / Course / Workshop in association with / on behalf of Marc Edwards or Associated Training Provider (REPs Accredited or not) and any Training Session/Course/Class/Workshops including (but not limited to) any of the following names:


Marc Edwards Fitness / K5 Health and Fitness / Universal Training / Universal Fitness Training / Universal Martial Arts Training / Universal Personal Training / K500 Kickboxing
I agree to adhere to the terms and conditions, rules and regulations set forth by Marc Edwards (full T&Cs in the link below) which are clearly displayed in the Studio. I also understand that I will be solely responsible for my own welfare whilst using the studio and subsequently, the safety and welfare of anybody accompanying me whilst I use the facilities.


Terms and Conditions

Full Terms and Conditions can be downloaded by clicking HERE but in a nutshell;

  
Respect the box and the box will respect you
  
Book your time slots at least a week in advance
  
Leave the place as you find it
  
Report any defects ASAP
  
Remove outdoor footwear before you enter
  
Train only with the programme you're given by your trainer
  
Don't be a dumbass and get stuck under some weights you're not strong enough to lift
  
You break it, you buy it
Use it or lose it.... basically NO REFUNDS
  
Don't steal anything, I know where you live
  
Ask questions if you're unsure of anything
  
Enjoy the place. It's the only 24/7 private studio around!
Name
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