Battle Boxing Gym Youth Program

Battle Boxing Gym Youth Member Registration

Ages 5- 12
Name*

First NameLast Name
Age*
Weight
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Battle Boxing Gym's Youth Program is not a certified therapy session. Coach Elijah is not a professional therapist but is studying to become a youth pastor. Elijah has the insight to detect internal issues with a person but is not licensed to treat or diagnose someone. He will talk to the parent about what he sees, but his purpose is to allow your child to open up and begin to speak about anything that's going wrong, to hopefully come up with a suggestion for you to have your child treated.

Training sessions are closed, meaning no parent interference.
Has your child been bullied or the bully?

BulliedThe bullyMy child is just extremely passiveNo
Is your child experiencing behavior issues at home or/and school?

All the timeSeldomNot at allIt's a serious issue
Has child been diagnosed with anxiety/depression, ADD, ADHD, or on medication?

YesNo
Has your child had any form of boxing or martial arts training?

Boxing onlyMartial arts and boxingNone
How active is your child?

They're currently in a sportAlways outside playingStays in front of the tv, tablet, cell phoneAbsolutely lazy
Are there any specific behavioral issues? Please explain
Why do you want your child to learn boxing?
My Products
prevnext( X )
PER SESSION TRAINING
$30.00 Quantity



Monthly 16 workout sessions to be used within one month.
$100.00 Quantity



Boxing Gloves All leather boxing gloves are designed to fit your youth correctly and protect their wrists and hands.
$55.00 Quantity



Total

$0.00
Once you have submitted this form, you can bring your child to their first session that fits your schedule. Coach E trains youth Monday - Thursday from 5:30 pm to 6:45 pm.
Signature

Clear

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Battle Boxing Gym Youth Member Registration