The Gym Academy Enrolment Form

To complete this form you will need a current photo ID. (e.g. you can take a photo of your driving license or passport and upload to this form)

Personal Information

Photo ID (passport or driving licence) *

Title *

New Starters Name *

First Name Last Name

Nationality *

Address (for manual & certificates) *

Street Address
Street Address Line 2
City	County
Post Code	Country

Date of Birth *

Day Month Year

E-mail *

Mobile phone number *

Emergency Contact Name *

Emergency Contact Number *

REPS registration number (if applicable)

If you have already opted for a Personal Training placement after graduation at one of our clubs and you have already attended a club meeting / interview and have had the position confirmed please indicate below.

Career Package *

Preferred Club *

How did you hear about us? *

Your Career Advisor / Assessor *

Course Details

Choose how you would like to study: *

Choose your level: *

Choose your workshop location: *

To attend this course you are required to be Level 2 qualified. Please upload your Level 2 Certificate *

To attend this course you are required to be Level 3 qualified. Please upload your Level 3 Certificate *

Course Start Date (Full Time)

Course Start Date (Part Time)

Payment Method

Payment Method - please specify *

Credit Card / Debit Card - payment in full Credit Card / Debit Card - deposit paid; Direct Debit payment plan Divido Finance

Was finance applied for under your name? *

Yes No

Name on Divido application

I wish to pay today: *

The deposit (non refundable) The full amount via www.thegymacademy.com/book

To pay either the deposit or the full amount visit - via www.thegymacademy.com/book

If an employer is paying for the course please send the official purchase order number on the company’s letterhead

I wish to be invoiced and my purchase order number is: *

Ethnic Origin

In order to help us monitor our equal opportunities policy, please best describe your ethnic origin: *

Please state *

Learning Needs or Disabilities

Do you have any learning needs or disabilities that may require support during your course? *

No Yes

Please state: *

Social Media

Are you happy for us to include you in photos and videos on Social Network sites: *

Your Instagram page:

Agreement

Please check all your information is correct before signing. *

I understand that by signing this form I agree to the terms and conditions and am entering into a binding contract with The Gym Academy to purchase the learning products and that I agree to pay all monies due., I declare that to the best of my knowledge all the information supplied on this form is true at the time of booking.

A copy of this form will be sent to the email address provided above

Please provide a valid Signature *

Date Signed

Day Month Year