Fight for Change Registration Form

Thank you for registering your child with Fight for Change, Inc. We are a nonprofit organization providing support and guidance to at-risk youth in the Midlands. Our goal is to help instill discipline, confidence, independence, and self-awareness, and promote healthy life choices. Fight for Change is also a Christian-based organization, and we believe that spiritual guidance is vital to the development of our youth.

We would love to see your youth a part of something that could change their lives forever. They are the key to our future, and with strong, disciplined lives, the sky's the limit.

When bringing them to train, feel free to stay or come back an hour or so later to pick them up.

Please park on either side of the building, and not in front.

This program is for all children aged 12-18.

You do not need to schedule a time; our coaches are always available during the times listed above. If we are closed, it will be posted on our website. We do close for every federal holiday.

Training

Monday: 3 pm - 6 pm

Wednesday: 3 pm - 5:30 pm

Friday: 3 pm - 6 pm

Participants may attend at any time during these hours to receive a full hour of training. Please be mindful of normal Battle Boxing Gym hours. Participants arriving close to closing time may not receive the full training time.

We are also closed on all federal holidays.

Attire

Your youth must come prepared to work out. This means shorts, a t-shirt, and sneakers. Please no slides, Crocs, or flip-flops. Women may wear spandex, but we ask that they not wear sports bras. Tank tops over a sports bra are fine. Males are asked not to wear compression shorts as bottoms; they may wear shorts over them.

PLEASE BRING A BOTTLE OF WATER. We have a water refill area. Please make sure they have eaten. We will not coax any child into working out. If they refuse to train or throw a tantrum, they will be sent home.

We are excited to train, develop, and support your youth and see the change that comes from being part of Fight for Change!!

Participant's Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date*

MonthDayYear

Parent's Name

First NameLast Name

Parent's Phone Number*

Parent's E-mail*

example@example.com

MEDICAL HISTORY

Have you had any family history of chronic disease (heart disease, diabetes, etc.)?*

If yes, please list

Have you ever been diagnosed or treated for any chronic disease including asthma?*

If yes, please list

Are you currently taking any medication?*

If yes, please list

Any other conditions that we need to be aware of (i.e. Past or present injuries, etc)?*

If yes, please list

PERSONAL DETAILS

If you have answered YES to any of the above questions, you must obtain a

medical clearance prior to carrying out a physical exercise program.

HEALTH RELATED BEHAVIOURS

Do you smoke?*

If yes, how many a day?

Do you drink alcohol regularly?*

If yes, how much per week?

How many times on average do you eat fast food per week?*

How many hours of sleep do you normally get per night?*

PSYCHOLOGICAL

Please rate the following. One star being negative to five stars being positive

I have a positive attitude towards things

I am always stressed out.

I am in the best shape of my life.

I would rate my current health.

I am serious about acheiving my goals

GOALS

Do you have any health related goals (i.e. Lower blood pressure, etc)?*

If yes, please list

Do you have specific goals related to body composition (i.e. weight loss, build biceps etc)?*

If yes, please list

Do you have any performance specic goals (i.e. Increase 10km run, increase chest strength, etc.)?*

If yes, please list*

Do you wish to achieve any of these goals in a specific time frame?*

If yes, please explain

I agree, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity with Fight for Change, Inc.

Having such knowledge, I hereby release Fight for Change and its affiliate, Battle Boxing Gym of their representatives, agents, and successors from liability for accidental injury or illness, which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in said fitness program.

Who referred you to Fight for Change, Inc.?*

LIABILITY WAIVER

Please read carefully before submitting form.

Please tick box in agreement to the above liability waiver*

I Agree

Signature

My Products*

Fight for Change Registration

$250.00 Quantity

Total

$0.00

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info