Be The Proof Community Registration

Free Youth Boxing Program – Sign-Up Form Boxing • Discipline • Confidence • Community Support
Welcome!
Please complete this form to register your child for the Free Youth Boxing Program. This helps us keep your youth safe, supported, and placed in the correct training group.
Pick A Location
Youth Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Number
Youth Phone (optional)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School
Grade
SECTION 2 — PARENT / GUARDIAN
Parent / Guardian Full Name

First NameLast Name
Parent / Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent Guardian Email
example@example.com
I consent to being contacted by
Emergency Contact Name & Phone Number
SECTION 3 — BOXING CONSENT + SAFETY
Does your child have any medical conditions we should know about?
If yes, explain medical conditions, injuries, or allergies.
ALL BOXES MUST BE CHECKED IN ORDER TO PARTICIPATE
SECTION 4 — MEDIA & SCHOOL SUPPORT
Type a question
SECTION 5 — SIGNATURE
Signature
Date

MonthDayYear
Date
Please verify that you are human
Should be Empty:

Free Youth Boxing Program – Sign-Up Form Boxing • Discipline • Confidence • Community Support