BWL Electronic Waiver
Please take a minute to fill in the following information.
First Name
Last Name
Date of Birth
Email
Phone Number
Address
Have you ever boxed before?
Yes
No
How did you hear about us?
Mall
Facebook
Instagram
Google
Friend/Family
Other
Do you have any special medical conditions?
Yes (please specify below)
No
Please list any medical conditions or injuries that may prevent you in performing physical activity.
ASSUMPTION OF RISK
I hereby acknowledge and understand that taking part in training programs and events held at Boxing with Love LLC may lead to injury, illness or even death. I understand that risks inherent in any physical activity including but not limited to falls and injuries sustained as a result of contact with other participants. I am full responsible for my safety and other risks that may incur during and after participating in the activies at Boxing with Love LLC.
PHOTOGRAPHY
I hereby acknowledge and understand that I may appear in photographs and/or videos posted on social medial and/or the Boxing with Love website.
REPRESENTATION
I am over the age of 18 and declare myself to be medically and physically fit to participate in classes provided by Boxing with Love LLC. Guardian signature required if participant is under the age of 18.
I agree to the terms & conditions
Your Signature
*
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Emergency Contact Name
Emergency Contact Number
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