Youth Registration | Next Round Life Cham

YOUTH PROGRAM REGISTRATION

Welcome to Next Round Life Champs NFP INC. Please complete this registration form for your child’s participation in our youth boxing and life-skills programming. The information provided helps us maintain a safe, structured, and supportive environment for every participant.

PARTICIPANT INFORMATION

Participant First Name

Participant Last name

Participant Date of Birth

Month

Day

Year

Gender

Male

Female

Prefer Not To Say

PARENT/GUARDIAN INFORMATION

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Participant

Parent/Guardian Phone Number

Parent/Guardian Email Address

Parent/Guardian Home Address

EMERGENCY CONTACT INFORMATION

Emergency Contact First Name

Emergency Contact Last Name.

Emergency Contact Relationship to Participant

Emergency Contact Phone Number

MEDICAL INFORMATION

Does the participant have any medical, physical, developmental, behavioral, or mental health condition that could affect their safe participation in boxing, conditioning, or physical activity?

Yes

No

If yes, please describe all medical or health conditions we should know about. Include any diagnoses, injuries, surgeries, medications, allergies, physical limitations, activity restrictions, accommodations, or emergency instructions.

Examples: asthma or breathing conditions; heart conditions; concussions or head injuries; seizures; diabetes or blood sugar conditions; bleeding disorders; bone, joint, muscle, neck, or back injuries; vision or hearing concerns; allergies; medications; developmental, behavioral, or mental health conditions; and any doctor-ordered restrictions.

I authorize Next Round Life Champs NFP INC to photograph or record the participant during programs and events and to use the content for nonprofit promotion, education, fundraising, grant reporting, website, social media, and community outreach without compensation. The participant’s full name or identifying information will not be shared without separate permission.

I certify that the medical and health information provided in this registration form is complete and accurate to the best of my knowledge. I understand that I am responsible for informing Next Round Life Champs NFP INC of any changes in the participant’s health, medications, injuries, medical restrictions, or ability to safely participate.

In the event of illness, injury, or medical emergency, I authorize Next Round Life Champs NFP INC to provide reasonable first aid, contact 911, and arrange emergency medical care when necessary. Reasonable efforts will be made to contact the parent/legal guardian or emergency contact. I accept responsibility for costs associated with emergency medical care.

I understand that participation in boxing training, conditioning, fitness activities, drills, and related activities involves inherent risks, including but not limited to falls, collisions, strains, sprains, fractures, cuts, bruises, dental or eye injuries, concussion or other head injuries, and other serious injury. I understand that injuries may occur even when reasonable safety precautions, supervision, and protective equipment are used. I knowingly acknowledge and accept these inherent risks

To the fullest extent permitted by law, I, on behalf of myself and the participant, voluntarily release and hold harmless Next Round Life Champs NFP INC, its directors, officers, coaches, staff, volunteers, agents, representatives, and participating facilities from claims arising from the ordinary risks inherent in participation in its programs and activities. This release does not apply to claims or rights that cannot legally be waived under applicable law.

Parent/Legal Guardian Certification: I certify that I am legally authorized to complete this registration and provide the permissions and authorizations above. By signing below, I acknowledge that I have read, understand, and agree to the terms above.

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Date Signed

Month

Day

Year