Boxing Canada - Membership and event registration

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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

Your Expertise or Specialty in Sports Event Management (Multiple answers possible) *

Languages Spoken (Multiple answers possible) *

Do you have a valid First Aid certification (CPR/AED)? *

If yes, upload First Aid certification

Do you have any mobility or environmental sensitivities or limitations? *

If yes, please describe how we could facilitate your volunteer tasks.

Do you have a valid driver's license? *

If yes, would you be comfortable driving a designated vehicle as part of your duties?

T-Shirt Size *

Willingness to Travel (Select all that apply) *

Medical License Number – Upload License *

Years of Experience in Sports Medicine *

Holds Malpractice/Professional Liability Insurance *

Number of Olympic-style or Amateur Boxing Bouts Won

Number of Olympic-style or Amateur Boxing Bouts Lost

How many bouts in Pro Boxing, MMA, kickboxing, muay thai, or other combat sports, including both amateur and professional

Total Number of Olympic-style or Amateur Boxing Bouts

Membership type

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

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Membership type (Boxing Newfoundland and Labrador)

Membership type *

Category *

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

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Membership type (Boxing Canada)

Membership type *

Category *

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

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

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

Please fix the following errors:

Are you sure this individual isn’t the following:

Other Information

Membership type

Membership type (Boxing Newfoundland and Labrador)

Membership type (Boxing Canada)