CHS Boxing Club - Registration Form
Gym member/participant
Name
*
First Name
Last Name
Birthdate
*
Street Address
*
City
*
Contact Number
*
Please enter a valid phone number.
Contact Number - Type
*
Home
Cell
Email
School Name (Students Only)
*
Grade (ex. 4th grade)
Please indicate prior boxing experience (Ex. # of years trained, location/facility, time period, etc.) - Enter "NA" for no prior experience
*
Prior participation in other contact sports:
*
YES (LIST DETAILS BELOW)
NO
Contact Sports - Details
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
List Name(s) and Phone Number(s) for persons authorized for student Drop off/Pick up (Ex. John Doe - 8431112222) Enter "NA" if over 18 years
*
IMPORTANT STATEMENT: CHS Boxing Club has the right to refuse training or entry to the facility if medical clearance is not provided. Furthermore, we reserve the right to refuse training and entry to the facility without the proper personal equipment or violation of its code of conduct. I understand that I am responsible for providing proof, via electronic or hardcopy, that I am registered and in good standing with USABOXING before I am allowed to begin training. I understand that if I enter the building or boxing ring without such proof, I do so at my own risk.
By signing, I agree to the statement above (Parent/Guardian must sign on behalf of minor chid)
*
List any and all medical conditions, allergies, or illnesses that may be aggravated by rigorous exercise. Enter NA if not applicable.
*
By signing below, I confirm and agree that I am free of any pre-existing injuries or contagious diseases and have been medically cleared to fully participate in all activities and training with CHS Boxing Club. (Parent/Guardian must sign on behalf of minor child)
By signing, I agree that I have read the registration form. I fully understand and agree with the statements and terms listed. (Parent/guardian must sign on behalf of the minor child)
*
Submit
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