EMF Lifting & Laughing Specialised PT Inquiry Form
Name of child/teen if under 18
Name of parent or guardian if applying on their behalf
First Name
Last Name
Age of child/teen
Date of Birth
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
County
Eir Code
Tell us a little more about you or the person you are applying for.
What made you decide to fill out this form today?
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Has your applicant ever done PT in the past or have they any experience doing resistance training? If so please tell us how they felt about it and if there was anything they didn't like about their experience.
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Does your applicant have any previous injuries (sport or otherwise)? Do they have any medical issues which may effect their ability to perform any exercises? Please feel free to go into as much detail as possible.
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What are you hoping for your applicant to get out of training in EMF? Please feel free to go into as much detail as possible.
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How comfortable is your applicant at taking instruction? How comfortable are they with being in a new environment? Do they get shy easily or do they struggle socially?
*
Prior to starting a membership we complete a 30 minute induction/assessment session at a cost of €35. Here we get to know your applicant and assess their physical ability and comfort in taking instruction. This session involves doing some simple exercises and includes lots of chat so we can assess if they would be a good fit for our gym. Is this ok?
Yes
No
We offer 4 x 30 minute sessions over 4 weeks. These sessions are private 1 to 1 sessions and include a mixture of strength, coordination, balance and skill focused exercises with an emphasis on fun. These sessions are €140 every 4 weeks. We do also offer a sibling rate if more than one person wants to train in the session, i.e brother and sister etc. Is this ok?
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Yes
No
What are your applicants favourite things such as music, sports teams, video games, movies, etc?
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Due to child protection we require a parent or guardian to stay for the session if the individual in the session is under 18. If another staff member is in the buidling at the time of your session we do not require you to stay. Is this ok?
*
Yes
No
Date Signed
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Applicant/Parent/Guardian Signature
*
Submit to EMF
Should be Empty: