ANA Boxing gym Registration
Name of Boxer
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Boxers age on completion
Boxers Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Boxers phone number
*
Please List any medical History (any Medication we should be aware of).
*
Name,Phone number and email of Emergency contact.
*
Please list reason for joining the club
*
To compete
To keep fit
Mental health reasons
other
Please read and check the waiver provided.
*
I understand that boxing and fitness training involve a risk of injury.
I confirm that I am medically fit to participate in training activities.
I agree to follow all gym rules and the instructions of coaches and staff.
I accept responsibility for my own actions while participating in training.
understand that the gym, its owners, coaches, and staff are not liable for injuries or losses sustained during participation, except where liability cannot legally be excluded.
I understand that I participate at my own risk.
I consent to my picture being taken and used on the clubs socials
I have read and understood this waiver and agree to its terms.
Signature
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