New Era Boxing Club Questionnaire Name * First Name Last Name Email * Phone * (###) ### #### Emergency Contact * First Name Last Name Relationship Parent, Sibling, Spouse, etc. Phone * (###) ### #### How did you hear about us? Do you have any medical conditions? What are your fitness goals? Select all that apply Weight loss Conditioning Endurance Muscle-building How would you describe your current knowledge of exercise and fitness training ? Beginner Average Advanced Are you currently part of a team / sports club? If yes, please specify the sport/team. Do you currently, or have you participated in any form of boxing classes? Select all that apply Yes, boxing for fitness Yes, boxing to compete, either amateur, professional or UWCB Yes, youth boxing or school based boxing No If you were to enroll in a class, what time would suit you best? What’s your favorite type of exercise? Why did you choose to join New Era Boxing Club? Thank you!