2022-2023 SEASON - WINDMILL AMATEUR BOXING CLUB | EST 1989

WINDMILL AMATEUR BOXING CLUB | EST 1989

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Participant Registration Form | 2022-2023

Membership Form 2022-2023

Please read the 'CODE of CONDUCT 2022-2023' before completing this form.
Participant Details
Forename (s) *
Surname *
Date of Birth *

Day Month Year
Date
Age (years) *
Address (Line 1) *
Address (Line 2) *
Post Code *
What is your gender ? *

Male Female
What ethnic background/origin do you class yourself as (optional) *

Asian Arab Black White
Emai Address *
Contact Number *
Emergency Contact
Name *
Relationship *
Contact Number *
Exercise Readiness Questionnaire
Have you ever been advised by your GP/Doctor, not to undertake exercise? *

NO YES
Do you have a bone or joint problem that could worsen by undertaking exercise? *

NO YES
Have you ever been advised by your GP/Doctor, not to undertake exercise? *

NO YES
Do you suffer from spells of dizziness or feeling feint? *

NO YES
Do you ever get chest pains, caused by exercise or high intensity tasks (i.e. cleaning) ? *

NO YES
Have you ever had high blood pressure? *

NO YES
Are you currently taking any medication? *

NO YES
Are you pregnant, or have had a baby in the last 6 months? *

NO YES
Is there any other information, reason or cause which may affect you whilst exercising? *

NO YES
Any other information (Include medication, injuries, surgery etc - please write CLEARLY)
COVID Vaccine: *

YES - 1st Jab YES - 2nd Jab NO Exempt
CLUB MEDIA: I would like to be included in media for club promotional purposes - including, but not limited to photography, video, audio or print. I understand that from time to time the club will give the rights and any media to third parties for editorial and broadcasting purposes (this applies to all media). *

YES NO
Membership valid from 1st August 2022 until 31st July 2023.

Membership is non-refundable.
DECLARATION - Participant *
DECLARATION - Parent/Guardian (for members under 18 years of Age)
DATE: *

Day Month Year
Date
Membership Fee £35 - due for activation on 01/08/2022 ( expires on 31/07/2023 )
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MEMBERSHIP FEE 2022/2023 Membership is valid between1 August 2022 until 31 July 2023.Members will be entitled to multiple discounted services and benefits.NOTE: The membership expires 31 July 2023 - regardless of when it's taken on after 1 August 2022. This is a NON-REFUNDABLE fee.
£ 35 one-time payment
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