KBC Waiver & PAR-Q

Client Information
Kingsway Boxing Club Ltd. does NOT share any of the below contact information or emails with anyone or any other companies. We also do NOT send out any advertisements via e-mail. The information you provide is strictly confidential.
Full Name Of Participant*
First Last
Compay/School Name
Please list the name of school or company if applicable.
Date Of Birth*
MM
DD
YYYY

_________________________________
Email*
If participant does not have a personal email address, please include the address of the parent or guardian.
Phone*
Address
(not required unless registering for a program)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this your first visit to Kingsway Boxing Club?*
- No
- Yes
How did you hear about our club?
What type of program(s) are you interested in?
Please explain your health and fitness goals:
Be sure to note any special requests or requirements so your trainer/coach can best help you achieve your goals.
Your Coach*
If you know who your session has been booked with, please select below.

WAIVER
Agreement Waiver*
I hereby release and hold harmless The Club, its agents, officers and employees and any affiliated companies from any liability with respect to any injury of any nature suffered by me or to my property arising out of or in any way connected with my, or my children’s participation in any boxing or such related activity from the below date onward.
- I Agree
  *Participant must have hit their 18th birthday to accept the agreement. If you are the parent or guardian, please see the next section.
  (by submitting this form and checking this box works as your digital signature)
* Participants under the age of 18
Participant must have hit his or her 18th birthday to accept the agreement. Parent or Guardian must sign on behalf of the minor if under 18.
First Last

If My Mind Can Conceive It & My Heart Can Believe It,