Membership Application Form

Membership Application Form

In order to join Brechin Boxing Club, please fill out this form. If you are under 18, please ask your parent or guardian to sign this form.
Are you completing this form on behalf or yourself or a child:*
Reason for joining the club:

To register as a recreational/fitness memberTo register as a boxing memberTo register as a kickboxing member
How many classes per week do you plan to attend?
Name

First NameLast Name
Child's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Phone Number*
Email*
example@example.com
Date of Birth*

DayMonthYear
Emergency Contact
Name

First NameLast Name
Phone Number
Relationship to you
Physical Activity Readiness Questionnaire

Do you have, or have you had in the past:*

	Yes	No
History of heart problems, chest pains or stroke within your family
Increased of low blood pressure
Advice from Doctor stating not to exercise
Surgery within the last 12 months
Pregnancy now or within the last 3 months
History of breathing or lung problems
Muscle, joint or back disorder or any previous injury affecting your ability
Diabetes or thyroid condition
Hernia or condition that may be aggravated by lifting weights
Any recent injuries
Any other condition not previously mentioned

Please provide additional details below
I declare to the best of my knowledge I know of no reason why I should not participate in a personalised programme, exercise class or sparring session. I take part in any recommended programme, exercise class or sparring session at entirely my own risk and waive any legal recourse for damages or property arising from my participation.*

Understood and Agreed
All club policies can be found in the club office but we'd like to highlight some now.

Code of Conduct

Officials of the club (Officers, Coaches and Committee members):
- Follow all policies and procedures laid down by Boxing Scotland
- Abide by the rules of the club
- Adopt a high standard of behaviour, setting example to others
- Promote discipline and fairness at all times
- Earn the trust and respect of all participants through profesionalism
Parent/carers of under 16s:
- Encourage your child to abide by the rules of the club
- Discourage dissent/conforntation with Coaches, Offiers and Committee members
- Do not force your child into participation
- Never punish your child for underperforming
- Help your child to enjoy the sport
Members/participants:
- Respect your fellow members, including Coaches and staff
- Respect the gym, its equipment and facilities including toilets and changing rooms
- Respect the Club; you are a representative of the Club. Inside AND outside of the gym
- Arrive on time! It's your time, you've paid for it. Do not disrupt members by arriving late
- Wear appropriate clothing for training. NO OUTDOOR FOOWEAR
Please respect the following Club Rules and DO NOT hassle volunteer staff on reception to make exceptions.

The Club reserves the right to refuse entry and/or ban exisiting members and/or their parents/guardians if they do not comply.

CCTV Recording

The objectives of the CCTV system is:
- to promote a safe community environment
- the protection of staff, members and volunteers
- the prevention, investigation and detection of crime
- to monitor the security of the club premises
The CCTV system will NOT be used to provide recorded images for the internet.

The storage of all recorded imagery will be:
- stored fairly and lawfully processed
- relevant and not excessive for the purpose
- accurate, securely stord and not kept for longer than is necessary
Cameras will be located externally and internally at Brechin Boxing Club.

The systems will operate 24 hours per day, 365 days per year.

Only authorised persons at Brechin Boxing Club wil be able to review recorded and live images.

Staff, members and other individuals may apply to have CCTV footage reviewed. The request must be made in writing to the Boxing club, including the date, time and location of footage recorded and the reason for the request. All requests should be made within 9 woking days of the recording to ensure footage is not erased.

Unless required for evidential purposes or the investigation of a crome or otherwise required by law, recorded images will be retained for no longer than 30 days from the date of recording.

At the end of their useful life all recorded images will be erased and securely disposed.
Please confirm you have read, understood and agree to adhere to the Code of Conduct and CCTV Recording Policies*

Yes
Brechin Boxing Club Training Disclaimer (Adult 18+)

By signing this form I understand that participation in the above activities could include actions or tasks which might be hazardous to me. I agree to train under the instruction of Brechin Boxing Club coaches, which includes the correct and safe use of equipment. I assume any risk of harm or injury which might occur to me in my participation in the activity. I release Brechin Boxing Cub from all liability, costs and damages which might arise from my participation in the above name activity.
Brechin Boxing Club Training Disclaimer (Junior Under 18)

I, being the parent/guardian of the above named child agree that they can take part in the activities of the club.

By signing this form I understand that participation in the above activities could include actions or tasks which might be hazardous to him/her. I agree that he/she can train under the instruction of Brechin Boxing Club coaches, which includes the correct and safe use of equipment. I am satisfied that he/she is responsible and competent to assume responsibility for his/her safety while attending Brechin Boxing Club sessions.

I undertand that in the event of injury or illness all resonable steps will be take to contact me, and to deal with the injury/illness appropriately. I agree that the club can seek emergency medical treatment for my child if required.
Signature*

Clear
Date

DayMonthYear
Date
Should be Empty:

Membership Application Form

Emergency Contact

Physical Activity Readiness Questionnaire