Athlete Registration

Personal information

Last name *

First names *

Nickname (in everyday life)

Fight name/ Nickname in the ring

Nationality *

Gender *

Male

Female

Date of birth *

Place of birth *

Address *

Country *

Phone / whatsapp *

Email *

Facebook

Instagram

Club & Coach

Team/Gym/Club *

Trainer/coach *

Medical information

Doctor *

Health insurance # *

Conditions (Answer all questions: if yes, please tick and explain below)

I have glasses / contact lenses

I am diabetic

I have epilepsy

I have allergic reactions (please explain)

I take medication regularly (please explain)

I have other health conditions (please explain)

Explanation

Have you ever been knocked unconscious? If “yes”, duration of unconsciousness, date and particulars.

In case of emergency

Name *

Relationship *

Mobiel *

Combat sports Records & Achievements

Amateur Boxing (Wins - Losses) *

Pro Boxing (Wins - Losses - Draws) *

Thai-Kickboxing (Wins - Losses - Draws) *

MMA (Wins - Losses - Draws) *

Titles

Weight (in kilogram) *

Photo in boxing stance with white background *

Upload a good quality photo where the face is clearly visible

The undersigned declares to have completed this form truthfully and agrees to the terms, provisions and is fully aware that with the practice of combat sports like boxing risks are involved. Participation in any activity is done at own risk. CuraBox (Curacao Boxing Association) and representatives cannot be held liable for personal injuries and accidents of any kind. The undersigned hereby already now as then to give up all his / her right to bring a damages action against CuraBox and / or representatives, which he / she damages could claim for expenses, damages and interest resulting from any injury or injury incurred as a result of sports.

In the case of a minor (person under 18 years), a legal representative (parent/guardian) must sign.

Signature *

Reset Signature

Signature is required.