Membership Your Name(valid email required)DOB(required)Email(valid email required)Address Including Post Code(required)Telephone Number(required)Telephone Mobile(required)OccupationEmail of parent/carer of minorNext of Kin/Parent/Carer Next of Kin/Parent/Carer contact numberHealth Questions In an emergency and also to establish your physical readiness to exercise please answer the following questions. These will be treated in the strictness confidence;Blood clotting disorders?YesNoHigh or low blood pressure?YesNoElevated blood cholesterol?YesNoDiabetes?YesNoChest pains brought on by physical exertion?YesNoEpilepsy?YesNoDizziness or fainting?YesNoA bone, joint or muscular problems?YesNoAsthma or respiratory problems?YesNoAny sustained injury or illness?YesNoAny allergies?YesNoAre you on any medication?YesNoHas your doctor ever advised you not to exercise?YesNoAre you of any reason not noted above why boxing may not be suitable for you?YesNoAre you up to date with your tetanus?YesNoI have read the club rules and agree to abide by them. I will not hold the club or coaches liable for personal injury. My personal effects and equipment are my own responsibility.YesNoParent/guardian; I agree for my child’s image to appear in press and the media featuring the club’s activities.YesNoParent/guardian; You agree for the club to seek immediate medical attention if your child should need it, including transfer to a hospital. YesNoI have completed the health questionnaire accurately and will advise the club of any change in my/my child’s medical condition that may affect my/my child’s ability to participate in the boxing training. I give permission for my details to be stored on a secure computer database and for the club to send me emails.YesNoPlease answer the question below What colour is snow?