Haymakers for Hope - Fight Continued 2024 Application

Haymakers is offering a specialized (non-contact) version of the four month Haymakers training journey specifically to those who have been directly affected by cancer.

This Program seeks to introduce individuals who have battled cancer to the benefits of boxing including:
- Improved physical, mental + social health
- Strengthened quality of life
- Lowered chance of disease re-occurrence
- Financial stability, knocking down monetary barriers to entry
Where: Nonantum Boxing Gym - Newton, MA

When: The Programming will start in January/February 2026.
- Sun 8:45 am
- Wed 6:30 am
- Fri 7:30 am
Attendance will be required two times per week.
Registration Info
Full Name

First NameLast Name
Birthdate

MonthDayYear
Date
What is your gender?
City
State
Contact Number
Format: (000) 000-0000.
Email Address
example@example.com
How did you hear about Haymakers for Hope? Please list name(s) if referred by friend/family/alumni
Medical History
Check the conditions that apply to you or any member of your immediate relatives:

Other
Check the symptoms that you' re currently experiencing:

Other
Are you currently taking any medication?
Please list them.
Do you have any medication allergies?
Please list them.
Do you use any kind of tobacco or have you ever used them?
What kind of tobacco products? How long have you used/been using them?
Do you use any kind of illegal drugs or have you ever used them?
What kind of drugs? How long have you used/been using them?
How often do you consume alcohol?
Cancer Diagnosis
Year of Diagnosis
How long have you been cancer free?
Forms of treatment
Please list all surgeries and surgery dates related to cancer diagnosis.
Are you on medication for high blood pressure?
Do you take any medication to regulate your blood sugar?
Do you have a heart condition or are you on medication for your heart?
Emergency Contact Info (please list name/cell phone/relationship to you
Should be Empty:

Registration Info

Medical History