Back "*" indicates required fields Application for Membership for World Gym Bundaberg Boxing TournamentName* DOB.* Month Day Year WeightAddressPHEmergency Contact Name PHReason for Boxing Training For Fitness Self-Defence Self Confidence Please Select: to compete in boxing- Hand wraps are compulsory to wear in our GymAny Illness: Any Medication: Have you ever competed in Boxing or any other combat sport: if yes, name of Gym and how many fights: I do give Full Permission* Yes i do I do give Full Permission to participate in sparring after a full medical examination has been carried out. I hereby acknowledge that I am taking part in Academy Boxing Activities at my own risk entirely and hereby undertake not to make any claim against the Academy, namely-Attila Boxing Academy Bundaberg, or against any member of the Academy, or coach for any injury that may be incurred during training or on fight night. I further hereby acknowledge that I participate in this Boxing Tournament at my own risk and that Phoenix Health Clubs Pty Ltd T/A World Gym Bundaberg will not be liable for any personal injury , loss or liability whatsoever arising as a result of , in connection with your undertaking with this Boxing Training and /or Tournament. Photos will be taken and published only for boxing related images. I hereby agree to abide by the rules and regulations of the Boxing Academy and World Gym Bundaberg. Signature*Parent or guardian must sign for persons under 18 years of age.Parent or guardian must sign for persons under 18 years of age.Where did you hear from our Boxing Academy?... Fee paid Date Month Day Year PhoneThis field is for validation purposes and should be left unchanged.