<p>Registration Form Welcome to Thetford Town Boxing Club.</p><p>To ensure we have the correct contact details for you, please fill out this form and return it as soon as possible. We will also use this information to ensure that you are kept informed about club events.</p><p>Member Name:</p><p>Date of Birth:</p><p>Parent/Carer Name: (If under 16)</p><p>Address (Incl. postcode)</p><p>Contact telephone number (s)</p><p>Email address (required)</p><p>Emergency contact details Please insert the information below to indicate the person(s) who should be contacted in event of an incident/accident.</p><p>Contact name & Relationship e.g. spouse/parent Emergency contact number</p><p>Sporting information Have you taken part in Amateur Boxing before? Yes  No  </p><p>If yes, with whom have you taken part through (please indicate below)</p><p>Recreational  Local authority session(s)  Club  County  Other (please specify) ______Have you taken part in ANY combat sport before (UK or Overseas)? Yes  No  If Yes, please provide details below of where & when & type of sport</p><p>Medical information: Please detail below any important medical information that the Club should be aware of (e.g. epilepsy, asthma, diabetes etc.)</p><p>Please detail name of Dr & Drs Surgery you are registered with, including telephone number.</p><p>Disability The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial 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 </p><p>If yes, what is the nature of your disability?</p><p>Please detail below any important medical information that the Club should be aware of:</p><p>Visual impairment  Hearing impairment  Physical disability  Learning disability  Multiple disabilities </p><p>Other (please specify)</p><p>By returning this completed form, I (we) agree to abide by the Clubs codes of conduct (a copy of these are available in your registration pack).</p><p>I do/ do not give permission for the Club to contact me from time to time to give with information and activities that may be of interest to me.</p><p>I do / do not give permission for photographs to be taken by TTBC of my training / bouts and used for publicity purposes (via website/Facebook/local/national media.</p><p>Name of member: …………………………………………………………………………………………….</p><p>Signature of member: …………………………………..Date: …………………………………………..</p><p>Signature of parent/carer (if under 16 years)……………………………………………………………….</p><p>Thetford Town Boxing Club Use Only: Taster Session Complete? Yes/No Date: Membership Fee Paid? Yes/No Date: Member category Junior/Senior Membership Form Filed Date: By (volunteer name)</p><p>Whilst it is not compulsory that the next section is completed the following information will help our club monitor its membership and to evaluate for our external funding sources.:</p><p>Ethnicity Please tick one of the following boxes to identify your ethnic group/origin. A. White British  Irish  Any other white background (please specify) ______B. Mixed White & Black Caribbean  White & Asian  White & Black African  Any other mixed background (please specify) ______C. Asian or Asian British Indian  Pakistani  Bangladeshi  Any other Asian background (please specify) ______D. Black or Black British Caribbean  African  Any other Black background (please specify) ______E. Chinese or other ethnic group Chinese  Any other (please specify) ______</p>