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SBC Registration Form

Gender*

Date of Birth*

Age*

Title*

Type of Membership*





Has your doctor ever said that you have a heart condition?*
Have you recently had chest pains bought on by exercise?*

Are you currently receiving treatment/ medication for high blood pressure?*

Do you have bone or joint problems that could be aggravated by exercise?*
Do you often feel faint or have dizzy spells?*

Do you suffer from epilepsy or chronic asthma?*
Is there any possibility that you may be pregnant or given birth in the last 6 months? (Miscarriage, pregnancy, fertility problems)?*
Are you diabetic Type I or Type II?*

Have you undergone surgery in the last six months?*
Are you over the age of 65 and not accustomed to vigorous exercise?*

Is there any reason not mentioned above that would stop you taking part in an exercise programme or boxing training?*

As far as you are aware, are you allergic to any drugs or medication?*

If you answer yes to question 3 and/ or more questions you will need to bring a letter from your doctor stating you are fit to take part.

Do you consider yourself to have a disability?*

If you have a disability, please indicate which reflects your disability:

Declaration: I consider myself or my son/ daughter to be physically fit and capable of full participation and agree to notify the club of any changes to the medical information provided. I also state that I wish to participate in all boxing training activities that may include aerobic exercise, resistance exercise, stretching, and sparring. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in activities at the club. Furthermore, in the event that I am injured (or my son/daughter), I give my permission for the team managers/ coaches appointed by Stonebridge Boxing Club to obtain emergency medical treatment on my behalf.
I agree that my basic details be shared with funders.


ETHNICITY OF CLUB MEMBERS:*

Can we contact you by phonecall or text regarding our projects, service and events?*

Can we contact you by email regarding our projects, service and events?*

Can we contact you by WhatsApp regarding our projects, service and events?*

Date of Signing:*

Are you a guardian?*

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Stonebridge Boxing Club is a registered charity in England and Wales (No.1136707). Affiliates: England Boxing | Team Sauerland | Blackstone Sports Management

Working hours

Monday – Friday:
11:00 am – 10:00 pm

Saturday:
12:00 pm – 2:00 pm

Sunday:
10:00 am – 12:00 pm

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