Registration

If you’ve chosen an alternate payment method, such as e-transfer, you’ll need to complete this form as part of our registration process. We look forward to seeing you soon!

Section 1

IMPORTANT: If you are a returning athlete, you'll only need to complete Section 1 of this form. If changes have occurred since your last class, please fill out the entire form again. If you are a new athlete, you'll need to complete the entire form before we can sign you up for your first class.

Athlete name

Enter your first and last name.

First Name

Last Name

Enter your email address.

Do you/your athlete require one-on-one support?

Yes

Section 2

Athlete Information

Athlete age (if under 18)

Enter the age of the athlete upon registration.

Diagnosis/disability/support needs

Please enter the athlete's diagnosis, disability, or support needs as required.

Preferred Communication

Please select the preferred communication method of your athlete below.

Verbal

Sign Language

PECS

Other

If other:

If another form of communication is preferred, please explain below:

Medical needs

Please describe any medical needs/concerns/alerts (eg. allergies, asthma, heart or kidney disease, history of seizures).

Things we should know

Is there anything else you would like coaches to be aware of about you/your athlete?

Section 3

Emergency Contact

Emergency contact name

Please entire first and last name.

First Name

Last Name

Emergency contact phone number

Please enter the emergency contact phone number.

(###)

###

####

Emergency contact relationship

Please enter the relationship with the athlete.

Alternate contact name

Please enter an alternate emergency contact first and last name.

First Name

Last Name

Alternate contact phone

Please enter the phone number of your alternate emergency contact.

(###)

###

####

Alternate contact relationship

Please enter the relationship with the athlete.

Section 4

Photo Consent

Photo consent

I consent to the use of my name, portrait, picture, photograph or video as part of Boxing Without Barriers' image and video bank. This is a collection of images and videos intended to showcase the club's activities. The images in this collection will be used on Boxing Without Barriers' website, as well as in club publications and marketing products such as social media, displays, pamphlets and presentations. Should I wish to have my name, portrait, picture, photograph or video removed from the image and video bank, my contact for doing so is: Chantal Deketele Beaver Boxing, 145 Spruce Street Ottawa, ON K1R 1C6 Email: boxingwithoutbarriers@gmail.com I agree that I shall have no claim against Boxing Without Barriers, Beaver Boxing or anyone accessing this publication, whether online or in print. I confirm that I am over 18 years of age and that I have not given anyone the exclusive right to use my name, portrait, picture, photograph, or video.

Yes