State Boxing Tournament Entry Form
Register to compete in the state boxing tournament. Please provide accurate details and review the participation waiver below.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Boxing Club or Gym Name
*
Coach's Name
*
Weight Class
*
Please Select
Light Flyweight (up to 49 kg)
Flyweight (52 kg)
Bantamweight (56 kg)
Lightweight (60 kg)
Light Welterweight (64 kg)
Welterweight (69 kg)
Middleweight (75 kg)
Light Heavyweight (81 kg)
Heavyweight (91 kg)
Super Heavyweight (over 91 kg)
Boxing Experience (years)
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you received medical clearance from a physician to participate in boxing competitions?
*
Yes
No
Participant Signature (draw your signature below)
*
Submit Entry
Submit Entry
Should be Empty: