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BOXING - MONTHLY
BOXING MONTHLY MEMBERSHIP FORM
Please complete our membership application form and let’s get you fighting fit!
Has a doctor / medical professional ever diagnosed you with a heart condition and indicated you should restrict your physical activity?
Yes
No
When you perform physical activity, do you feel pain in your chest?
Yes
No
When you were not engaging in physical activity, have you experienced chest pain in the past month?
Yes
No
Do you ever faint or get dizzy and lose your balance?
Yes
No
Do you have high blood pressure or a heart condition in which a doctor / medical professional is currently prescribing a medication?
Yes
No
Are you pregnant?
Yes
No
Do you have insulin dependent diabetes?
Yes
No
Are you 69 years of age or older and not used to being very active?
Yes
No
Do you know of any other reason you should not exercise or increase your physical activity?
Yes
No
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Give us a call on 0203 026 9602
First Name
Last Name
Date of Birth - dd.mm.yyyy
Phone/Mobile
Email
Confirm Email
We will keep you up to date with all the latest news from the club and keep in touch with you at key points to help you achieve your fitness goals.
I wish to receive emails
I wish to receive SMS texts
Emergency Contact Name
Emergency Contact Mobile
Post Code
House Number
Street Address
Town
Billing Address
This must be the address that is registered with your bank (if different from above).
How did you hear about us?
- Select -
Friends
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Boxing Monthly
£60.00
for each
month
Pay with Card (Stripe)
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Terms and Conditions
and
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