Free Women’s Boxing Class

Full Name *

Contact Email *

Phone Number *

Date of Birth *

GenderMaleFemaleNon-binaryIntersexQueerTrans ManTrans WomanOtherPrefer not to say

Ethnicity *Asian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - Any other Asian BackgroundBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British any other Black BackgroundMixed Heritage - White & Black AfricanMixed Heritage - White & Black CaribbeanMixed Heritage - White & AsianMixed Heritage - Any other ethnic BackgroundWhite: BritishWhite: IrishWhite: Gypsy/TravellerWhite - any other white BackgroundOther Ethnic Group: ArabOther Ethnic Group: Any other Ethnic BackgroundPrefer not to sayNot Recorded/ Not Given

ReligionAtheistBuddhistChristian (All Denominations)SikhHinduMuslimJewishAny other religionNo religionPrefer not to sayNot Recorded/ Not Given

Disability YesNoNot Provided

Type of Disability Physical DisabilityMental Health needLearning DifficultiesOtherNot Recorded/ Not Given

Health Issues *

Food Allergies *

Date you want to attend *

Attendee Home Post Code *

How did you hear about the programme *Treasure BoxingFriendsLeafletParent/CarerNewsletter (any)CouncilOur City WebsiteSchoolOther

Notes - Any Relevant Information *

Treasure Boxing - Disclaimer & Waiver it is imperative that you read & sign this disclaimer & waiver before booking a Treasure Boxing class. This Must be submitted for every participant taking part. No participant will be allowed to take part without this form submitted. *

Disclaimer: Boxing is a physically strenuous exercise. In order to participate in the classes, you MUST, therefore: be of reasonable health, and you warrant that this is the case & that you have disclosed to us at the time of booking any & all medical conditions, medication or other issues that could have an impact on your participation in the activity prior to it commencing. *

I consent to have photos & videos taken for the purpose of marketing & promoting activities of Treasure Boxing on their social media accounts & website. *YesNo