CMBC Registration Form

Central Maui Boxing Club

Registration Form
Monthly membership fees of $80 for each child under the age of 19 are due upon receipt of registration forms and due prior to first class, along with a one time fee of $25 for new members. A CMBC official will contact you via email or phone upon registration.
Athlete Personal Information
Full Name*
First, Last MI
DOB*
mm/dd/year
Sex*

MaleFemale
Address*

Home Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip*
Parents Phone*
Parents Email*
`example@example.com
Attending School*
Parent/Guardian
Emergency Contact 1*
Relationship To Athlete *
Phone*
Emergency Contact 2
Relationship To Athlete
Phone
Pre-existing Injuries or healthcare concerns
Athlete Physical Condition*

PoorGoodExcellent
By signing below, I/We understand and appreciate that participation in any sport carries a risk of injury. I/We voluntarily and knowingly recognize, accept, and assume this risk. We understand that BOXING IS A CONTACT SPORT AND THAT INCIDENTAL AND INTENTIONAL PHYSICAL CONTACT MAY OCCUR in classroom session during instruction and class drills. Sore muscles and other body parts are facts of life in a contact sport and are likely to occur. I/We hereby waive and release all rights to any claim for damages for any injury suffered by me during my participation. I/We certify that the participant is deemed to be in good health and has been seen by his/her doctor and I/We know of no other injuries that may occur.
Signature of Parent or Legal Guardian if under 18 yrs. of age required
Print Name
Signature*

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By signing below, I/we do hereby consent to the use of my and/or child/children's image in photography or video for fundraising, advertising, publicity, or any other purpose on behalf of Central Maui Boxing Club, Inc and Top Shape LLC dba Hoomana Barbell.
Signature

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Our Group code is Cmbc93
Date

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Central Maui Boxing Club

Athlete Personal Information

Parent/Guardian