Parent/Carer Referral Form - Boxing Camp

Referral Form

Please fill out the information below:

Referral date

Please read the information carefully, should you have any queries, please contact info@n3wangle.com

Young persons details:

Young person’s full name

Date of birth

Gender

Home address

What school does the young person attend?

What year group are they in?

Do you need to share any additional information?

Boxing Camp Sessions

Location: Whitley Amateur Boxing Club, 27 Callington Rd, Whitley, Reading RG2 7QH

For School Years 7-8 and Girls

Time: 11:00AM - 1:00PM

Select the dates you'd like to book:

Mon 30th March - Wed 1st April - Fri 3rd April: 11:00AM - 1:00PM

Wed 8th April - Fri 10th April: 11:00AM - 1:00PM

For School Years 9+ and School Leavers

Time: 1:00PM - 3:00PM

Select the dates you'd like to book:

Mon 30th March - Wed 1st April - Fri 3rd April: 1:00PM - 3:00PM

Wed 8th April - Fri 10th April: 1:00PM - 3:00PM

Parent/Carer contact details:

Your full name

Your phone number

Your email address

Relationship to the young person

Emergency contact details:

Full name

Phone number

Email address

Relationship to the young person

Collector contact details:

Full name

Phone number

Email address

Relationship to the young person

Doctor contact details:

Doctor

Surgery

Phone number

Young persons information:

Does your child have any dietary needs?

If yes, please give details:

We do not allow nuts or nut products in any of our settings

Does your child have any allergies?

If yes, please give details:

Does your child have any medical conditions?

If yes, please give details:

Does your child take any medication?

If yes, please give details:

Does your child have an auto-injector?

If yes, please give details:

Does your child have any Special Educational Needs?

If yes, please give details:

Young persons consents:

I consent to my young person being filmed or photographed to be used for advertising

I consent for pictures or videos of my young person to be used on social media

I consent to my young person taking part in supervised controlled sparring*

I consent to my young person going home alone

I consent to my young person receiving basic first-aid treatments

I give N3W ANGLE consent to administer Paracetamol to my young person.

*bring headguard, gumshields and gloves if owned.

Thank you for taking the time to complete this form. By signing you are confirming your permission in relation to the above information and your child whilst attending a N3W ANGLE setting.

Any queries, please contact info@n3wangle.com

Contact Signature