Health declaration

Please ensure you fill out the form with current and accurate information. Failure to do so may have legal consequences. Thank you!

First name

Last name

Current Email

Current Phone

Current Address

Date of birth

Month

Day

Year

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

What is your primary reason for joining our boxing camp?

Single choice

Yes (please describe in the box below)

No

If yes Answer here

Initials (

I declare that the info I’ve provided is accurate and complete.