Sarina Boxing & Fitness Membership Form

Member Name

First NameLast Name

Date of Birth

DayMonthYear

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

What are your goals for training? I.e. Fitness, boxing skills & technique

How did you hear about us? (Facebook, Instagram, Google search, word of mouth

Do you suffer from any medical conditions/ allergies that the club/coach should be aware of? (Please include list of any current medications)

Do you have any injuries? (Please include any recent surgeries or acute musculoskeletal injuries)

Waiver, Release & Assumption of Risk

This form is an important legal document. It explains the risks you are assuming by beginning an exercise program. It is critical that you read and understand it completely. After you have done so, please type your name in the space provided at the bottom.

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 Sarina Boxing & Fitness.

Having such knowledge, I hereby release Sarina Boxing & Fitness, 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. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) ANY INJURY THAT MAY OCCUR AS A RESULT OF EXERCISING OUTDOORS INCLUDING INJURIES RELATIED TO DEBRIS ON EXERCISE SURFACES.

Member Name:

First NameLast Name

Parent/ Guardian (where applicable):

First NameLast Name

Gym Member Registration