Registration Form
(first time only)
Profile Details
Fighter Name
Phone Number
Format: (000) 000-00000.
E-mail
Emergency Contact
Contact Name
Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Student
Membership
Age Group
Please Select
5-10 (Kids)
11 - 17 (kids)
18+ (Adults)
Membership Type
Please Select
Fighter
Fitness Member
Kids Class
BoxFit
Personal Trainer
Par(Q) Questionnaire
1. Has a doctor ever told you that you have a heart condition or should only exercise under medical supervision?
Yes
No
2. Do you experience chest pain during physical activity?
Yes
No
3. Do you lose balance or experience dizziness?
Yes
No
4. Do you have bone, joint, or back problems that could worsen with exercise?
Yes
No
5. Are you aware of any other reason you should not participate in boxing or fitness training?
Yes
No
If yes to any question, Please provide details of your condition or injury:
Final Declaration
I confirm the above information is correct and I participate in training at my own risk.
Media & Social Media Consent
Photo & Video Permission (Optional)
Yes, I consent.
No, I do not consent.
Health & Training Consent
Health Consent
*
I confirm I am physically fit to participate in boxing and fitness training. I understand training involves risk of injury and I train at my own risk at Atlas Boxing Academy
Parents/ Guardian Consent
*
confirm I am the parent/guardian and give permission for my child to participate in boxing and fitness training at Atlas Boxing Academy. I understand training involves risk and agree to follow gym rules
Signature
Continue
Continue
Should be Empty: