Boxing Consent Form - HAILSHAM BOXING CLUB

Name *

First

Last

Parent/Guardian Name

First

Last

Complete if child under 16

Contact Telephone *

Address *

Email *

Date of Birth *

Emergency Contact and Phone Number *

Emergency Contact and Phone Number

Medical History Details:

Please provide any important medical information Hailsham Boxing Club* should be aware of including details of any conditions provided above.

Medical Disclaimer – *

All members (parents guardians for under 16’s) – I give my consent to the below:

I have considered the nature of Boxing Sessions with Hailsham Boxing Club* and confirm there is not any medical disability or medical condition (not disclosed above for myself or my child) that would have a detrimental effect to being able to participate safely in these boxing sessions.
I understand that in the event of injury or illness all reasonable steps will be taken to contact the named person(s) on this form and to deal with the injury or illness appropriately.
I further provide consent for Hailsham Boxing Club* to seek emergency treatment and in the event that the emergency contact (s) cannot be reached then Hailsham Boxing Club* may assume responsibility and give consent for any necessary medical treatment. I agree to accept financial responsibility for any subsequent costs related to this.
*registered Buchanan Boxing Limited

GP Name *

GP Phone and Address *

Boxing Training Disclaimer and Parental Consent for under 16's *

All members: I/my child agree to and the rules of service below

I understand that participation in the sport of boxing could include actions or tasks which might be hazardous. This agreement in to train with Hailsham Boxing Club* under the instruction of their coaches which includes the correct and safe use of the gym equipment. I agree to release Hailsham Boxing Club* from all liability, costs and damages which might arise from participation in above named activity.
I have read, understood and agree to the information contained in this disclaimer and have by ticking the above Boxing Training Disclaimer given consent to taking part in Boxing Sessions with Hailsham Boxing Club*
*registered Buchanan Boxing Limited

Photo/ Video Consent

I give permission for Hailsham Boxing Club* to use my/or my child’s photo/video for reasons stated below:

Hailsham Boxing Club* recognize the need to ensure the welfare and safety of all young people taking part in training within the Boxing Club.
In accordance with our child safeguarding policy (Copies of which can be found on our website) we will not permit photographs of young people to be taken without the consent of the parents/guardians. As your child will be taking part in our training sessions we would like to ask permission to take photos/ videos to be used for:
1. A record of the activity
2. Publicity material for Hailsham Boxing Club* on social media, websites, posters and press releases
3. Future grant applications
*Registered Buchanan Boxing Limited