Boxing Registration Form

Fall Teen Boxing with Dom

Boxing Registration Forms

6221 Sooke Road

Participant's Information

Participant's Name*

First NameLast Name

Between ages of 12-16 ?*

YesNo

Participant's /Legal Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Boxing skill level*

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Competiting?

YesNo

List below the following reasons you decided to join this boxing program? (Examples : Strengthening upper- body and core. Boosts endurance. Improving hand-eye coordination, competing, confidence etc. )

Important Notes · Dress appropriately. · No food or drink in the gym ( only water ). · Keep the gym clean. · Fee: $220 per person (includes $25 one time registration charge, includes a pair of hand wraps). Participants that want to compete will be able to transition to competition classes once approved by your coach.

Hours of Operation

Tuesday : Teens 5pm-6pm

Thursday : Teens 5pm-6pm

Emergency Contact

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Does you have any allergies, breathing conditions , or medical conditions that would limit high level activtiy?*

YesNo

Please describe*

Release of Liability Although the safety of all sport activities is the primary concern, indoor sport activities at Sooke Boxing may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Sooke Boxing Club and the persons in charge.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at sookeboxing@gmail.com

My Products

$220.00CAD

Fall registration w/registion fee

Total $0.00CAD

Payment Methods

Debit or Credit Card

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