Club Membership Form
Welcome to POSEIDON Amateur Boxing Club. Whether you wish to compete in the noble
art of boxing or simply wish to enjoy a non-contact workout, we welcome you to the club.
Please fill in the information below for our records as it forms part of our risk assessment and
equity policy and your details will allow us to tailor your training around your individual
requirements, experience and abilities.
Section A – Personal Details
Forename
Surname
DOB
Nickname
Age
Gender
M
F
Home Tel No
Address
Mobile Tel No
Email Address
Emergency Contact details: (Please insert the information below to indicate the person (s) who should be contacted in the
event of an incident/accident)
Section B - Medical Information
Please detail below any important medical information that our coaches should be aware of (eg
epilepsy, asthma, diabetes, low blood pressure, high blood pressure etc)
Current
medication
Any current
injuries
Any known
medical
conditions
Section C – Boxing/Contact Sport Experience
Have you taken part in
boxing training/ contact
sports before?
Yes
No
Section D –Competitive Boxing Experience
Have you had a
bout before?
If yes to above, for how long
have you been boxing
training?
If yes to ques
above how many
bouts have you
had?
Where did you train?
What club did you
box for?
Would you like to box
competitively?
Yes
No
Maybe
Have you had a
boxing medical?
What was the date
of your last boxing
medical?
Yes
No
Total
Won
Lost
Section E - Demographics
Whilst it is not compulsory that the following sections are completed, the footnote at the end of
this membership form explains why it is important1
Ethnicity
In order to help the club monitor its membership, please will you tick one of the following boxes
to identify your ethnic group/origin.
A - White
British
Irish
Any other white background
(please specify below)
B - Mixed
White and Black Caribbean
White and Asian
White and Black African
Any other mixed background
(Please specify below)
C – Asian or Asian British Pakistani
D – Black or Black British
Indian Bangladeshi
Any other Asian Background
(Please specify below)
Caribbean
African
Any other Black Background
(Please specify below)
E – Chinese or other ethnic Group
Chinese
Any other ethnic group
(Please specify below)
Disability
The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or
mental impairment, which has a substantial and long-term adverse effect on his or her ability to
carry out normal day-to-day activities’.
Do you consider yourself to have a disability?
Yes
No
If yes, what is the nature of your disability?
Visual impairment
Hearing impairment
Physical disability
Learning disability
Multiple disabilities
Other (please specify):
1
Sport can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally
existed within sport, particularly in relation to gender, race and disability. Poseidon ABC and the ABAE is committed to
promoting and developing sports equity, which is about fairness in sport, equality of access, recognising inequalities and taking
steps to address them. By monitoring the profile of young people in sports clubs, the ABAE and Sport England can identify
issues relating to under-representation of different groups and can together develop strategis to ensure everyone has an
opportunity in the future development of sport. Boxing is a special type of sport whereby it is not suitable or possible to be
made safe for everyone to take part and therefore the ABAE Rules over-ride any disability discrimination regulations.
Where did you hear about us?
Please tick:
Word of Mouth
Open Days
Fliers
Posters
Newspaper
Free ads
Other please state below
Declaration
I, ___________________ , have read, understood and agree to adhere to Poseidon
ABC’s Club Child Protection Policy, Club Equity Policy and Code of Conduct for
Members. I understand that if I fail to comply with such Club policies that I may be
subjected to the Club’s disciplinary policy and procedures. I understand that I will
participate in boxing sessions under the instruction of qualified ABAE coaches
entirely at my own risk and I have been advised by Poseidon ABC to take out my
own personal accident insurance. I confirm that the information contained within this
membership form is accurate and correct and that I do not have any medical
condition or disabilities (not disclosed overleaf) that could affect my ability to
participate safely in boxing sessions.
Signature of Member:
____________________________
Name (in block capitals) ____________________________
Date:
____________________________
Joining Membership Donation
We ask that you consider contributing a one-off donation of £10 to become a
member of Poseidon Amateur Boxing Club. This payment is not compulsory to use
our facilities but if you join our club you will be kept up to date with club activities
including social and upcoming events and you will also receive a Poseidon goodie
bag including a club t-shirt. Should you agree you are asked to complete the form
overleaf which will enable us to claim gift aid on your donation, thereby helping us
raise much needed funds to be reinvested back into your club. The donation can be
made in cash or cheque payable to Poseidon Amateur Boxing Club. Thank you!