Please note that any identifying data, e.g. gym name and address will be removed when the applications are being considered to ensure fairness

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* 1. Gym name

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* 2. Email address would you like to be contacted?

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* 3. Please complete your address information

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* 4. Gym square footage

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* 5. Ratable value

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* 6. Rent per month

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* 7. Do you have any rent relief from your landlord or a holiday period

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* 8. Please specify your overheads per month

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* 9. How many members of staff do you have?

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* 10. Are the staff employed or self-employed, if employed are they furloughed?

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* 11. Are you Self-employed or a Limited Company

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* 12. Were you eligible for any grants/loans? If yes, specify how much and what they were

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* 13. How much revenue are you expecting for Jan 2021?

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* 14. How many members did you have before lockdown 3 and what was your monthly revenue

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* 15. How many members do you currently have?

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* 16. How members have you lost (cancelled)

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* 17. How many members have frozen their memberships?

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* 18. How much money do you need per month to keep the gym open?

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* 19. I confirm that I have completed the above information honestly and to the best of my knowledge. I understand that if I am found to have answered any of the above questions fraudulently, I will be required to return any money that has been received from the PTC.

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