BOXER APPLICATION FORM PERSONAL INFORMATIONFull Name* Age* Sex Male Female Weight (kg)* Height (cm)* Mobile Number Email* Postal Address How did you hear about PCR? Have you applied to Perth Corporate Rumble before?* Yes No Do You have a sponsor? Yes No Who is your sponsor? FITNESSOn a scale of 1-10, how fit would you describe yourself? 1 2 3 4 5 6 7 8 9 10 EXPERIENCEDo you have any previous boxing experience including fitness boxing? If yes, please specify. Yes No Specify ExperienceWhat do you want to gain from this experience?Do you have other sporting commitments between January - April 2022? Yes No If you answered yes to the above, please specify:MEDICAL HISTORYAre you currently taking any medication? If yes, please specify Yes No SpecifyDo you have a heart condition? Yes No Are you prone to fainting? Yes No Do you have high blood pressure? Yes No Do you have low blood pressure? Yes No Do you have any other underlying medical or physical injuries? If yes, please specify: Yes No SpecifyDo you spend time working away?* Yes No SpecifyAre you double vaccinated against COVID-19 or will you be double vaccinated by April 2022?* Yes No *As per direction from Crown Perth, all participants and patrons are required to be double vaccinated.EMERGENCY CONTACTEmergency Contact Name Emergency Contact Relationship Emergency Contact Phone I give permission for ANARCHY TRAINING CENTRE, GOBSMACKED SPORTS MOUTHGUARDS and GOBSMACKED PERTH CORPORATE RUMBLE to use my image for the events marketing strategy. I understand boxing is a contact and combat sport and I will do my best to listen to my trainers to help provide a safe boxing environment for myself and my fellow boxers. I understand the GOBSMACKED PERTH CORPORATE RUMBLE is a white collar boxing event and I will comply with the rules and regulations to keep the environment during training and the event fun, friendly and safe.* I Accept SignatureUse mouse or touchscreen to sign Δ
