Emergency Contact / Waiver Forms | Pena's Boxing Club

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Peña's Boxing - Des Moines

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Emergency Contact Form

YOUR OWN DETAILS:

First name

Last name

Email

Phone

Address

YOUR EMERGENCY CONTACT DETAILS:

Contact First Name

Contact Last Name

This contact is my

Contact Phone Number

Contact Email

Thanks for submitting!
We’ll contact this person only in case of emergency.

Gym & Fitness Liability Waiver

First name

Last name

Email

Date of Birth

Please specify anything we should know about

Type full name

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

Peña's Boxing Club - Des Moines, Iowa

2705 SW 9th ST, Des Moines, IA 50315

(515) 710-7393

penaboxingfoundationia@gmail.com

©2023 by Peña's Boxing Club - Des Moines

Pena's Boxing Club

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