Registration for an activity | Curacao Boxing Association

Is a Doctor currently treating you for anything?

Have you ever been unconscious or had a concussion?

Have you been hit hard in the head in the last 6 weeks?

Have you had any headache in the last 2 weeks?

Do you have any problem with bleeding?

Do you have a history of hepatitis B or hepatitis C or HIV infection?

Does any disease run in your family? Sudden unexpected deaths?

Have you had any surgery?

Have you ever been admitted to Hospital?

Do you have any medical condition?

Have you had medical treatment for anything in the last 3 months?

Have you suffered from any eye disorders or operations (including laser eye surgery)?

Have you suffered from any broken bones or cuts needing treatment in the previous 6 months?

Have you suffered from Epilepsy or any other type of fit, faint, convulsion or black-out?

Are you taking any medication now?

Do you presently have a cough, cold or runny nose?

Have you been unwell in the last month?