WORKING WITH THE NEXT GENERATION OF CHAMPIONS
DNA Level C Boxing Club Membership Form Waiver and Release of Liability, Assumption of Risk & Parental Consent & Indemnity Agreement
Application Date:
Parent's Last Name:
First Name:
MI:
Child's Last Name:
Child's First Name:
Email
Birth Date:
Age:
Address:
Apt #:
City:
State:
Zip:
Telephone #:
Cell:
U.S. Citizen YesNo
If not a citizen are you a Permanent Resident YesNo Birth Country:
MaleFemale
Have you competed professionally in MMA, ultimate fighting, Wildman, toughman or similar competitions YesNo
Register Now to get updates on Promotions & Coupons.