Boxing Canada - Membership and event registration

Are you sure this individual isn’t the following:

Are you a new or renewing member? *Member # * Lookup I am a new member

I am new to Boxing Canada
I am already a member or am renewing my membership
with Boxing Canada

Only this part of Boxing Canada #: XX-XXXX-XX-X-OOOO-XXXX

First Name *

Last Name *Is your Name incorrectly spelled?

Gender *

Male Female Gender Diverse

Date of Birth * (YYYY-MM-DD)

/ /

No category for this age.

Club

Full Mailing Address - Street Address *

Address 2

City *

Province/Territory/State *

Country *

Postal Code *

Individual Email * Opt in to emails

Phone Number * - International Number

Phone Number 2 - International Number

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone - International Number

Parent/Guardian Name

Parent/Guardian Relationship

Parent/Guardian Phone - International Number

Parent/Guardian Email Opt in to emails

Indigenous

No Yes

Military

No Yes

Law Enforcement

No Yes

Need Boxing Book

No Yes Sticker Only

Do you self-identify as a person with a disability?

If yes, please indicate the type(s) of disability you have

Other Information

Medical Form - Download here, fill out and then upload

Annual Medical Date

NCCP #

Coach Level

Please upload a criminal reference check and vulnerable sector check completed in the last 3 years

Date of criminal record check

Official Level

Citizenship

Membership type

There are no available categories for the age of this registrant.

Add another membership type

Membership type (Boxing Manitoba)

Membership type *

Category *

There are no available categories for the age of this registrant.

Add another membership type

Membership type (Boxing Canada)

Membership type *

Category *

There are no available categories for the age of this registrant.

Add another membership type

Waivers

I have read and agree *
Boxing Canada Waiver and Release of Liability

I have read and agree *
Boxing Canada Code of Conduct & Ethics

I have read and agree *
Boxing Manioba Waiver and Release of Liability

Please fix the following errors:

Are you sure this individual isn’t the following:

Other Information

Membership type

Membership type (Boxing Manitoba)

Membership type (Boxing Canada)

Waivers