Please enable JavaScript in your browser to complete this form.I have no know medical issues.ALL BOXERS: I certify that I have had no injuries to my hands, no fractures or broken bones, which exist now or occurred within three months preceding the date of the boxer membership application form, and know of no injuries to the head, concussion, fainting spells or headaches. I will notify my coach, trainer, or other Haverhill Inner City Boxing Club Staff immediately should any of these injuries or conditions be experienced in the future. I further agree that if I do experience any of the aforementioned conditions or injuries, I will immediately cease training and sparring until such conditions or injuries no longer exist.Please list any and all health restrictions, physical handicaps and any issues that Haverhill Inner City Boxing Club should be aware of:Signature of Applicant *Date *Signature of Parent/Guardian (if under 18)DateSubmit