Shamrock Boxing Gym

Shamrock Boxing Gym

Class Enrolment Form
Participant 1 Name*

First NameLast Name
Date of Birth if under 18 yrs old

DayMonthYear
Date
Weight (in kilos)
Participant 2 Name

First NameLast Name
Participant 2 Date of Birth if under 18 yrs old

DayMonthYear
Date
Participant 2 Weight (in kilos)
Guardian Name if under 18

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Do you have any prior fighting experience or training?
Chosen Class

Juniors 4-12 yrsAdvanced Juniors 12+Adult BoxingAdult FitnessI'd like to speak to someone first
I understand that boxing is an impact sport. By choosing to participate, you accept small injuries may occur from time to time.*

I accept
Option 1 (Preferred): Set up your Automatic Payment Schedule
prevnext( X )
Junior 4-18yrs 2 Nights Per Week $10 per class($20.00AUD for each week)

Recurring payments

Junior 4-18yrs 3-4 Nights Per Week($25.00AUD for each week)

Recurring payments

Adult Boxing or Fitness 2 Nights Per Week($20.00AUD for each week)

Adult Boxing 3-4 Nights Per Week($25.00AUD for each week)

Headgear - Juniors Required after 10 lessons - 10 payments($10.00AUD for each week)

Headgear - Juniors Required after 10 lessons - 1 payment of $100($100.00AUD one-time payment)
Option 2: Pay via Direct Debit. Please make payment until the end of the term.

Yes, I'll make the payment for the end of term, please email bank details.I'd like to pay via direct debit but please call me first
If in the junior class, what size shirt for participant 1?
If in the junior class, what size shirt for participant 2?
School Holiday availability? (for pairing similar size/weight/age participants in small classes)
Cancellations must be made at least 1 week in advance.

There are no refunds for change of mind, but we are happy to keep a credit for you.

If you choose not to continue lessons after 10 weeks, we will refund the cost of the headgear in full.

If the headgear has been used, we will buy it from you at 50% the paid amount.
Guardian or Participant Signature*

Clear
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