• Adaptive Boxing Series Registration

  • Join us for a virtual Adaptive Boxing Series!  Boxing can be done from a seated position or standing.  Classes will be held via Zoom.  All registered participants will receive the Zoom link prior to class.

     

  • I am registering for the Adaptive Boxing Series, Wednesdays, Nov. 4 - Dec. 9, 3:00PM - 4:00PM on Zoom.*

  • Participant Information

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Relationship to participant*
  • Format: (000) 000-0000.
  • What is your gender?*
  • Are you a Veteran?*
  • In which Branch(es) did you serve?
  • How would you best describe yourself?*
  • Are you of Hispanic/Latino/Spanish origin?*

  • Sports Association Membership

  • Have you participated in a Gaylord Sports Association Program in the past?*

  • If you are not a member of the Sports Association, or have not participated in a program in the last 3 years, please complete a member profile as part of your registration.  Click here to complete profile.  Please complete liability waiver and media release when linked to the page.

    Following completion, return and complete this Adaptive Boxing Series form. 

     

  • Program Registration

  • Medical Information

  • What is your primary diagnosis?*
  • Please indicate if you have any of the following conditions:*
  • Date of Injury or Illness*
     - -
  • Did you participate in previous Adaptive Boxing programs offered by the Gaylord Sports Association?*
  • Are you currently participating in a fitness routine?*
  • I currently exercise:*
  • I currently participate in the following fitness routine(check all that apply):
  • Are you cleared by a Doctor to participate in a fitness program?*
  • Are you able to get a Doctor's note if needed to participate in this program?*
  • How did you hear about this program?*

  • Acknowledgment

  • By submitting this form, I verify that the above information is current and accurate.  I understand that the above information will be kept confidential.  In order to provide a safe and fun experience your information may be shared with:  (1) Sports Association staff, coaches or instructors (2) other adaptive sports programs who will be working with you (3) medical professionals in case of emergency (4) as required for Sports Association grant reports.  I understand that it is my responsibility to inform the Sports Association regarding changes to my: (1) contact  information such as address, phone and email; (2) medical status including new diagnosis, surgery or medical changes; (3) any other information that is relevant to the safety of myself or others regarding my participation in Sports Association programs.  All participants are required to complete an annual liability waivers and media release(optional) prior to participation in Sports Association events.  You will be taken to the waiver forms after submission of registration.  

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