Membership Form

Please follow the steps and complete the full form.

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Membership Form

Please enter your full address and postcode

Contact Details

How would you like to be contacted?

EDUCATION, TRAINING AND EMPLOYMENT DETAILS

Under 18: Have you taken part in sport and/or physical exercise, outside of school, at least once per week for 30 minutes or more over the past 4 weeks?

Over 18: Have you taken part in sport and/or physical exercise, at least once per week for 30 minutes or more over the past 4 weeks?

How many exercise sessions of 30 minutes have you done in the past 4 weeks?

Boxing Information

DISABILITY

he Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’.

ETHNICITY

In order to help the club monitor its membership please tick one of the following boxes to identify your ethnic group/origin.

CCTV CONSENT

For security purposes, CCTV is installed and operational on this site. By becoming a member you agree to the recording, storage and usage of data in compliance with the DATA Protection Act 1998.

Please type your name as indication of your consent

MEDICAL DETAILS

Please detail below any important medical information that our coaches should be aware of (e.g. epilepsy, asthma, diabetes, etc.) *

PLEASE INFORM US IMMEDIATELY, IF YOUR MEDICAL DETAILS CHANGE

PARTICIPATION CONSENT

I, being the parent /carer have read the information contained on this form and hereby consent to him/her taking part in boxing activity sessions and understand and agree that he/she participates in boxing sessions under the instruction of ABAE qualified coaches entirely at his /her own risk. I have considered the nature of such sessions and have discussed them with him/her. I am satisfied that he/she is sufficiently responsible and competent to assume responsibility for his/her safety under the supervision of an ABAE qualified coach. I confirm that he/she does not have any medical disability or medical condition (not disclosed overleaf) that could affect his/her ability to participate safely in boxing sessions. - By returning this completed form, I agree to my son/daughter/child in my care taking part in the activities of the club. - I understand that I will be kept informed of these activities – for example timings and transport details. - I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. I have been made aware of and understand that the club will comply with the Moss Side Fire Station Boxing Club Child Protection Policy and Procedures including changing room, anti-bullying, travel, photography or video recording policies. In view of these policies I (*please delete as appropriate) do not wish* / accept * that he/she can be photographed or filmed for coaching or club promotional purposes. I have viewed and understand the Club Child Protection Policy

We may use audio or visual recordings and photographs during activities for the following purposes: ⦁ To be displayed on our website, Facebook and/or Twitter ⦁ To be displayed in publications ⦁ To be displayed in displays and exhibitions relating to our activities ⦁ Newspaper or general publicity purposes ⦁ Outreach material such as leaflets and posters for use internally and externally If you are 18 or over, and consent to appearing in our photographs or films, please sign the declaration below. I am 18 years or older, and I give my consent for photographs or film taken of me at the Moss Side Fire Station Boxing Club to be used for publicity or promotional purposes.

FOOTNOTE Sport can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally existed within sport, particularly in relation to gender, race and disability. Moss Side Fire Station Boxing Club is committed to promoting and developing sports equity, which is about fairness in sport, equality of access, recognition of inequalities, and taking steps to address them. By monitoring the profile of young people in sports clubs, both this club and Sport England can identify any issues relating to under-representation of different groups and can together develop strategies to ensure everyone has an opportunity in the future development of sport. Boxing is a special type of sport whereby it is not suitable or possible to be made safe for everyone to take part and therefore ABAE Rules over-ride any disability discrimination regulations.

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