2021-2022 Boston One Registration & Waiver
Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
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-
Month
-
Day
Year
Date
Phone Number
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-
Area Code
Phone Number
Gender
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Female
Male
Other
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have any health conditions or injuries we should be aware of? If yes, please discuss with a head coach (Lily Ting or Catherine Lin) before participating in your first Boston One activity.
*
Yes
No
Emergency Contact
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First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Proof of Vaccination
We require proof of vaccination. Please upload a picture of the front of your vaccination card.
Front of Vaccination Card
*
Browse Files
Cancel
of
Payment
Venmo @boston1dboat ($99 for U24 and $125 for non-U24 21-22 winter membership) ($20 for 2-class pass)
Boston One Waiver
For participating in Boston One sanctioned activities.
Boston One Waiver
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
*
Yes
Inner City Weightlifting (ICW) Waiver
For participating in ICW events during the offseason.
ICW recommends that participants get physician approval before participating in the activities and using the facilities offered by ICW. In the case of emergency, I authorize ICW personnel to seek medical treatment as necessary to ensure my well-being, and hereby consent to any and all such treatment.
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Yes
I, the undersigned participant, fully understand that participation in InnerCity Weightlifting (ICW) fitness programs may include actions or tasks which may be hazardous to my health. By signing below I voluntarily: (1)Assume any and all risk of harm or injury which might occur due to my participation in this fitness program; (2)Release ICW and its agents from all liability, costs and damages which might arise from my participation in the ICW fitness program; (3) Certify that my participation in the program, and signing of this waiver and release is knowing and voluntary. *
*
Yes
E-Signature
By signing, I acknowledge that I have read and understand this form and its waivers/releases of liability:
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