Register

Registration Form

Questions about this form? Contact Us with any questions.

Step 1 of 6

16%

Registration Information

Are you a returning ROH member?

Are you currently enrolled in school?(Required)

Yes

School(Required)

Select the Programs You Are Interested In(Required)

Youth Program (ages 8-14)

Monthly Unlimited Membership

‘Train Like A Pro’ Classes

Day Pass for Independent Workout

Schenectady High School

Private Sessions

Other

Select Initial Payment(Required)

Applicant Information

Name(Required)

First Last

Date of Birth(Required)

Month

Day

Year

Gender(Required)

Ethnicity(Required)

Black

White

Black & White

Asian

Hispanic/Latino

Multi Racial

Prefer Not To Say

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone(Required)

Email(Required)

Emergency Contact Information

Is the applicant under the age of 18?(Required)

Guardian 1 Name(Required)

First Last

Guardian 1 Phone(Required)

Guardian 1 Email(Required)

Guardian 2 Name

First Last

Guardian 2 Phone

Guardian 2 Email

Emergency Contact Name(Required)

First Last

Emergency Contact Cell(Required)

Medical History

ALLERGIES?

PLEASE LIST ANY MEDICAL CONDITIONS OR INJURIES THAT MAY PREVENT PHYSICAL ACTIVITY:

MEDICATIONS YOU FEEL ARE PERTINENT FOR ROH STAFF TO BE AWARE OF?

DOES APPLICANT CARRY INHALER OR EPI PEN?

Family Size / Income Level

Please select your family size and income level (based on HUD City of Schenectady Median Family Income)

Download Image

Family Size(Required)

HUD Schenectady Category(Required)

You can find what category you fall into by viewing the chart above

Waiver Acknowledgment(Required)

I have read the above waiver/acknowledgement of risk and understand the content

WAIVER / ACKNOWLEDGEMENT OF RISK: The activities that you will participate in with the Schenectady Ring of Hope Boxing Club are designed for those who are in adequate
physical condition and who are ready and able to participate in intense physical and cardiovascular conditioning. Boxing is a vigorous and
strenuous activities. BEFORE STARTING ANY WORKOUT ROUTINE GOING FORWARD, YOU SHOULD CONSULT YOUR
PHYSICIAN.
The reaction of the cardiovascular system to intense training is sometimes unpredictable. There is a risk of certain changes occurring,
during or following exercise; including but not limited to abnormalities in blood pressure, heart rate, or effective heart function and
possibly in some instances, heart attack or cardiac arrest.
Boxing and fitness training involve high impact punching, including striking of heavy bags, speed bags, punch mitts and double end bags,
as well as boxing drills performed with a partner or coach. There is an inherent risk involved in high impact punching; including but not
limited to, stress to virtually every muscle and joint in the body and most commonly to the hands, wrists, elbows, shoulders, neck and back.
For boxers who choose to participate in contact drills, there is always the possible risk of head injury/concussion. The intense training level
of our programs can bring about dramatic improvement in physical condition however, the training is designed for those who are already in
adequate shape and desire a higher level of conditioning. By signing this waiver, you signify that you accept these risks and take full
responsibility for any injuries or death that may occur as a result of this training and do not hold The Schenectady Ring of Hope Boxing
Club OR IT’S EMPLOYEES/VOLUNTEERS liable in any way.

Name of Person Signing (If Under 18, must be guardian signature)(Required)

First Last

Phone of Person Signing(Required)

WAIVER / ACKNOWLEDGEMENT OF RISK Signature(Required)

Your Name
Your Name
Your Name

MEMBERS UNDER 18 YEARS OLD –GUARDIAN PLEASE READ AND SIGN BOTH OF THE FOLLOWING

(1) CONSENT FOR EMERGENCY TREATMENT OF MINORS IN ABSENCE OF PARENT(S)/ LEGAL GUARDIAN(Required)

I agree to the terms below

I hereby give my consent and authorization for any emergency or non-emergency diagnostic procedure, medical, dental, surgical care and/or
hospitalization that any health care provider deems necessary; including but not limited to, any physician, dentist or hospital personnel providing
health care to the above-named minor.
In my absence, I hereby authorize the health care provider to discuss in full with the coach of the Schenectady Ring of Hope Boxing Club or
his/her designee, any medical information that is required to help make informed decisions on behalf of the minor named herein. I authorize the
coach or his/her designee to make decisions and to convey to the health care provider my consent to necessary treatment.
I hereby hold harmless any physician, dentist, hospital or hospital personnel, or other health care provider rendering such care to the minor from
any liability resulting from the failure to obtain consent from me as parent of the minor and from any other person. It is my intent that the person
or persons appointed herein shall be able to act in my stead in making such decisions.

Guardian Name(Required)

First Last

GUARDIAN SIGNATURE(Required)

Your Name
Your Name
Your Name

(2) MEDIA CONSENT FOR MINORS(Required)

I agree to the media consent terms below

I being the parent or legal guardian of the Minor in this form, hereby irrevocably
authorize THE SCHENECTADY RING OF HOPE BOXING CLUB, or their agents, employees, designee(s) and/or assigns; to use the minor’s
name and/or written and oral comments, work or materials provided, and to use all photographs, video, and/or audio recording taken by THE
RING OF HOPE, or their designees on social media platforms, news or media releases.

Guardian Name(Required)

First Last

Guardian Signature(Required)

Your Name
Your Name
Your Name

Youth Program Only (Please Read & Sign)

I agree to the terms below

At the Schenectady Ring of Hope Boxing Club, our mission is to enhance the lives of young
people by providing a safe space, discipline, support and opportunity for friendship and personal
growth. We take pride in our mission and in ourselves. We expect the same from our boxers.
Whether you are in the gym or out, you and your behavior represent The Ring of Hope at
all times. Therefore, we expect you to conduct yourself with integrity and pride and to abide by
the following:
I WILL respect myself, my classmates, my coaches and the gym!
I WILL always try my hardest!
I WILL NOT use vulgar language, because I am better than that!
I WILL encourage and support others!
I WILL stay focused and follow directions (the 1 st time).
I WILL NOT argue with ANY COACHES
I WILL keep my hands and feet to myself unless directed otherwise!
I WILL NOT, under ANY circumstances, engage in physical altercations outside of the gym!
I WILL come prepared with gloves, wraps, and sneakers.
I WILL be responsible for my belongings and bring them home.
I WILL clean up after myself – equipment / garbage / bathroom / belongings; because it’s the
right thing to do!
I understand that The Ring of Hope has my best interest in mind and if I do not hold myself to
these standards, my coaches and the staff at the ROH, will take disciplinary action, which may
include suspension and/or dismissal.

Boxer Name(Required)

First Last

Boxer Signature(Required)

Your Name
Your Name
Your Name

Parent / Guardian Name(Required)

First Last

Parent / Guardian Signature(Required)

Your Name
Your Name
Your Name

Register

Registration Form

Registration Information

Applicant Information

Emergency Contact Information

Medical History

Family Size / Income Level

MEMBERS UNDER 18 YEARS OLD –GUARDIAN PLEASE READ AND SIGN BOTH OF THE FOLLOWING

About

More Information

Gym Hours