Northolt Patrick Wilson Sob

Lord Halsbury Memorial Playing Fields, Priors Farm Lane, Northolt, Middlesex UB5 5FE

Want to box?

Please fill in the online form below, click submit to send and somebody will contact you with further information.

Boxer Details

Full name: Gender: Age: Weight (Kgs): Town/City: County Postcode: Phone No: Email:

Previous Boxing Experience

Have you boxed competitively, had bouts, for this or any other club before? Do you take part in any other sports? If YES, please state which sports: Do you intend to compete (contact) or train for fitness/weight loss only (Non contact)

MEDICAL HISTORY

Do you suffer from any medical condition that may prevent your partaking in the strenuous physical exercise associated with boxing training? (If in any doubt please consult doctor) If YES, please state details including medication:

Give any important medical information that the club should be aware of (e.g. heart conditions, epilepsy, asthma, diabetes, concussion or recent injuries).

DECLARATION

Please could you contact me with further information about joining the Northolt Patrick Wilson Sob boxing club. I have read the above questions and answered all to the best of my knowledge & belief. I understand that completion of this form is a simple request for further details about classes etc., and the content within does not form part of any application for membership that I may be asked to complete.