Youth Amateur Program Application (Under 18) Name * First Name Last Name Date of Birth MM DD YYYY School Parent/Guardian Name Parent/Guardian Phone (###) ### #### Parent/Guardian Email * Emergency Contact (other than parent) Emergency Contact Phone (###) ### #### Prior sports experience Boxing/Sparring experience None Beginner Some sparring Competitive Athlete goals Learn fundamentals Fitness Compete USA Boxing Confidence Discipline Availability Mon Tues Wed Thurs Medical/behavioral considerations we should be aware of USA Boxing Member ID (if any) Photo/Video Permissions “I consent to promotional use on gym channels (website/social).” “I consent to non-commercial gym photography/video for training review.” Parent/Guardian Consent * “I am the parent/guardian and consent to participation.” Thank you!
