Form

Name*

First NameLast Name

Age *

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

WhatsApp Phone Number *

Please confirm you’re happy to be added to a WhatsApp group with other sign ups for all information*

Yes

Please enter emergency contact and emergency contact telephone number below (include their relationship to you - Mam, Dad, Sister etc. *

Do you have any pre existing medical conditions*

YesNo

If yes please disclose here (confidential)

Have you had any heart conditions including palpitations or chest pain? *

You’ll need to attend at least 50% of training sessions in Penrhiwceiber - can you commit to this? (Tue & Thurs 6pm-8pm) *

You will need to sell a minimum of 15 tickets to fight can you do this? *

Will you be fundraising for a charity / cause?*

YesNo

If yes above will you be supporting our chosen charity - South Wales Samaritans? Or another charity / cause? (If another, please specify below)

Do you have any boxing experience?*

YesNo

If yes above, please confirm what experience and to what level (even if it’s only trained in a boxing gym with 0 fights)

Do you currently take any drugs? This includes PEDS/Steroids and or prescription drugs*

YesNo

If yes to above please disclose what drugs etc (confidential) - including for medicinal purposes

Do you have a criminal record? If so please disclose below (confidential) *

WWCB will take no liability for any injury caused during camp or during the fight - do you accept full liability for any injuries you may incur? *

Do you accept tickets are strictly non refundable - under any circumstances and if the show is for whatever reason postponed all tickets will be moved to a new date*

Yes

Why do you want to sign up? *

Signature*

Once signed up we will be in contact to add you to our fighters group within 48 hours. If this does not work please contact us on Facebook under Welsh White Collar Boxing

WWCB Cardiff April 4th Sign Up Form