Kingsway Boxing Club | Par-Q Waiver KBC Waiver & Par-Q Client InformationKingsway 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 NamePlease 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is this your first visit to Kingsway Boxing Club?* No Yes How did you hear about our club?(make selection)Google or Online ArticleSocial Media PostSaw the sign at one of the locationsFriend or Family MemberOtherWhat type of program(s) are you interested in?(make selection)Conditioning and Fitness OnlyRecreational BoxingSpecialized or Personal TrainingCompetitive BoxingOther (please specify below)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.PAR-Q & YOURegular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*YesNo2. Do you feel pain in your chest when you do physical activity?*YesNo3. In the past month, have you had chest pain when you were not doing physical activity?*YesNo4. Do you lose your balance because of dizziness or do you ever lose consciousness?*YesNo5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*YesNo6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*YesNo7. Do you know of any other reason why you should not do physical activity?*YesNoIf you have answered “Yes” to one or more of the above questions...Please explain the the questions you answered "Yes" to. Important Note: If you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.WAIVERAgreement Waiver*I have read and agree to the Terms and Conditions outlined at: https://kingswayboxingclub.com/terms-of-memberships-and-services. I hereby release and hold harmless Kingsway Boxing Club, its agents, officers, employees, and affiliated entities from any and all liability for injuries to myself, my child(ren), or my property, arising from or in connection with participation in boxing or related activities, effective from the date below. 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 18Participant 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
