First Name

Last Name

First Name Required Last Name Required

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Address Line 2: Address Line 2 is not valid

City: City is not valid

Country: Country is not valid

State/Province: State/Province is not valid

Zip/Postal Code: Zip/Postal Code is not valid

Email - Main Contact:* Email - Main Contact is Required

Gender:* Gender is Required

Ethnicity:* Ethnicity is Required

Date of Birth :* Date of Birth is Required

Medical Information : Medical Information is not valid

Phone Number: Phone Number is not valid

Parent/Guardian Name: Parent/Guardian Name is not valid

Parent/Guardian Phone Number: Parent/Guardian Phone Number is not valid

Parent/Guardian's Email Address: Parent/Guardian's Email Address is not valid

Notes: Notes is not valid

Is this form being filled on behalf of the student?

I declare that the information given in this form is true and complete to the best of my knowledge and consent to the above mentioned becoming a member of the West City Boxing Academy. *

I give my express permission that all photos taken and video footage recorded by WCB during the membership can be used by the West City Boxing Academy or by any third party (such as Funders) with the consent of the West Auckland Youth Development Trust/West City Boxing Academy, including use on Social Media (Website, Facebook, Instagram, YouTube). *

I acknowledge that West Auckland Youth Development Trust/West City Boxing Academy has a Vulnerable Children’s Policy and will follow this if this member is deemed to be at risk. (If you would like to view this policy please check out our website for more information - www.westcityboxing.nz ) *

I accept that the possibility of injury is inherent in undertaking physical activity (e.g. boxing). I will not hold West Auckland Youth Development Trust/West City Boxing Academy responsible for any injury or loss associated with this member while attending the Academy. *

I give my express permission for West Auckland Youth Development Trust/West City Boxing Academy to take all responsible action to seek medical attention this member require it at my own expense. *

I acknowledge that in accordance with the provisions of the Privacy Act 1993, the following information has been brought to my attention: This form collects sensitive personal information about me and/or a child under my care. *

Child Name 1: Child Name 1 is not valid

Child Name 2: Child Name 2 is not valid

Child Name 3: Child Name 3 is not valid

Important: Your Login Credentials

The email and password below will be used to log into the Member Portal (or Family Dashboard if you have multiple children). You'll need these credentials to activate the membership by setting up a payment method.

Registering multiple children? Each child requires a unique email address.

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Pay West City Boxing

Free

Competitive Team – Payment

Free

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