Boxing Club Application

Full Name*

First NameLast Name

Birth Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

If your a minor, do you have parents permission to join?*

If yes, parent/guardian Signature

MEDICAL HISTORY

Have you ever been diagnosed or treated for any chronic disease including asthma?*

If yes, please list

Are you currently taking any medication?*

If yes, please list

Any other conditions that we need to be aware of (i.e. Past or present injuries, etc)?*

If yes, please list

PERSONAL DETAILS

Have you had any previous training?*

If yes, wrestling, boxing, mma, martial arts?

Purpose for joining? Fitness, Discipline, Competing,Self Defense Etc

How serious are you about achieving your goals

Parents , Boxing is a physical sport . Your child may get bruised or bloodied during a sparring session match. Do you agree to this type of training and letting your child spar in a control enviroment ?*

If you compete in tourneys during school year. Your required to have passing grades. If you need tutoring let coaches know.

Signature Required If you do not agree , they can still train the discipline, but will not be allowed to spar.

Do you wish to achieve any other goals in a specific time frame?*

If yes, please explain

LIABILITY WAIVER

Please read carefully before submitting form.

I agree, being aware of my own or my child's health and physical condition, and having knowledge that by participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity with UnderDog M.A Boxing Club.

Having such knowledge, I hereby release UnderDog MMA, their 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.

I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in said fitness program.

Minors are not allowed to train in combatives.

Please tick box in agreement to the above liability waiver*

I Agree

Underdog M.A Clubd application