Punch Out MS Registration

Punch Out MS

Registration

May 1, 2027
Punch Out MS is a charity boxing event bringing our community together to raise funds for the London Health Sciences Foundation in support of Multiple Sclerosis research and care.
Sign up for your opportunity to challenge yourself, be part of something bigger and make a difference!

Facility Location: 665 Dundas St Upper Level, London, ON N5W 2Z1
PARTICIPANT INFORMATION
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
Day of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Approximate Weght
T-Shirt Size
EMERGENCY CONTACT
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Athlete
TELL US ABOUT YOURSELF
What is your reason for applying?
Are you willing to commit to the training, challenges and physical demands involved in preparing for and participating in Punch Out MS?
Are you willing to actively participate in fundraising and promotional activities to help support Punch Out MS and its fundraising goals?
Do you have any boxing or combat sport experience?
Are you currently a member at a boxing or combat sports gym?
If you answered YES, state which gym you are a member of.
If you answered NO to the previous question, please type NONE.
What is your current fitness level?
How many days a week can you commit to training?
Please indicate your availability for classes (select all that apply).
Do you have any existing injuries, medical conditions or physical limitations that we should be aware of when determining your ability to safely participate in training and the event? Please provide details.
What is your preference for corner colour (we will do our best to accommodate your preference)?
The $250 participation fee is mandatory and non-refundable. Who will be responsible for covering this fee?
Participant Acknowledgement & Responsibilities
By registering for Punch Out MS at M.P.T Fitness & Boxing, I agree that:
- My participation in the boot camp is voluntary.
- I understand that boxing and fitness training involve physical activity and inherent risks.
- I will provide honest and accurate health information and notify the coaches of any injury, illness, or health concern that may affect my participation.
- I will follow all coaching instructions, safety guidelines, and facility rules throughout the program.
- I will treat coaches, staff, and fellow participants with respect.
- I understand that my participation may be modified or stopped at any time if there are safety concerns.
For current M.P.T Fitness & Boxing members:

I understand that if I am an active member of M.P.T Fitness & Boxing when enrolling in Punch Out MS, I cannot cancel or suspend my existing membership for the purpose of participating in the Punch Out MS boot camp.

Failure to comply with this requirement will result in removal from the Punch Out MS program.
Electronic Signature
By typing my full legal name below, I confirm that I have read, understood, and agree to the responsibilities, requirements, and policies outlined in this application.

My typed name serves as my electronic signature and confirms my agreement to the terms above.
Full Name

First NameLast Name
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

PARTICIPANT INFORMATION

EMERGENCY CONTACT

TELL US ABOUT YOURSELF

Participant Acknowledgement & Responsibilities

Electronic Signature