Selected portal · youth

Youth Membership Setup

Complete client information, waiver, and dues agreement in one step.

Boxing ProgramWhich boxing program are you interested in? *

Client Information

First name *Last name *

Street address 1 *

Street address 2

City *State *ZIP code *Phone number *Email address *Date of birth *Emergency contact name *Emergency contact phone *

Parent / Guardian

Parent/guardian full name *Relationship to minor *Parent/guardian phone *Parent/guardian email *

Additional Children

Add each child to the same parent account. Every child receives a separate application, waiver, member profile, attendance record, and fighter card.

Portal Login

This password creates your secure portal login now. After approval, use it with the parent/guardian email entered above.

Create portal password *Confirm portal password *

Liability Waiver

NORTH CAROLINA BOXING TRAINING LIABILITY WAIVER AND ASSUMPTION OF RISK

Participant Identification

This agreement applies to the participant named above, residing at NC.

Acknowledgment of Inherent Risks

I understand that boxing, fitness training, sparring, bag work, mitt work, strength and conditioning, and other gym activities involve inherent risks, including serious bodily injury.

Express Assumption of Risk

I knowingly and voluntarily accept and assume the known and unknown risks associated with participation.

Release for Ordinary Negligence

To the fullest extent permitted by law, I release and waive claims against Mad House Boxing, its owners, coaches, staff, and agents arising from ordinary negligence connected with participation. This does not release conduct that cannot legally be waived.

Safety Instructions

I agree to follow all coach instructions, gym rules, equipment requirements, and safety directions, and to stop activity when directed.

Emergency Medical Consent

If I cannot provide consent during an emergency, I authorize reasonable emergency medical care and understand I am responsible for resulting costs.

Parent/Guardian Acknowledgment, Consent, and Covenant

I confirm that I am the participant’s parent or legal guardian. I consent to the minor’s participation, acknowledge the risks and terms above, authorize emergency treatment, and agree that this acknowledgment applies on behalf of the minor and myself to the extent permitted by law.

I acknowledge that this electronic waiver will be treated as my signed agreement.

I certify that I am the parent/legal guardian and agree on behalf of the participant.

Optional: I consent to Mad House Boxing using photos or videos of participation for gym promotional purposes.

Waiver Record Preview

Ready to Sign

Participant: Not entered
Portal type: youth
Full address: NC
Date signed: 2026-09-02
Parent/guardian: Not entered

Electronic Signature

Minor participant: Not entered. The parent or legal guardian must sign below.

Type your full legal name as your electronic signature *Signed date

Dues

Youth Boxing Membership

$120 / month household total

Dues are due on the first of each month. This step records your dues agreement; it does not charge a payment method.

Payment method *Pay in CashPaid through World’sPay through StripeStripe is not connected yet.

I acknowledge the $120 monthly dues per child and understand they are due on the first of each month.