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Prénom *

Nom *

Sexe *

Homme Femme

Date de naissance (AAAA *-MM-JJ)

/ /

Équipe - Le vôtre manque ? *

Province/State *

Country *

Number of Bouts *

2026 Registration Number

I have received my Boxing Canada record book

Yes No Not applicable

I acknowledge and understand that I must have a valid medical, completed within the past 12 months, in order to participate in this tournament. I further agree to submit any updated medicals no later than February 2, 2026. *

Yes No

I understand and agree that if I withdraw from the tournament after the draw has been completed, I will be required to pay a $250.00 withdrawal fee. I further acknowledge that failure to pay this fee will result in me being classified as not in good standing with Boxing Ontario, which may prevent me from participating in future Brampton Cup tournaments, at the discretion of the event organizers *

I have read and agree to the withdrawal policy.

I understand and agree that if my membership expires at the end of 2025, I must renew my membership no later than January 20, 2026. *

I have read and agree to the above

Coach Name *

EMERGENCY CONTACT

Emergency Contact Name

Emergency Phone - Téléphone international

Relationship

Division

Division *

Catégorie *

J’ai lu et accepte les conditions *
CONSENT FOR USE OF PERSONAL INFORMATION, COMMERCIAL MESSAGES AND PHOTO RELEASE

J’ai lu et accepte les conditions *
CONCUSSION CODE OF CONDUCT

J’ai lu et accepte les conditions *
WAIVER OF LIABILITY FOR ALL CLAIMS AND RELEASE OF LIABILITY

J’ai lu et accepte les conditions *
ASSUMPTION OF RISK AGREEMENT

J’ai lu et accepte les conditions *
MEMBERSHIP WAIVER AND ACKNOWLEDGEMENT FORM-90 DAY POLICY

Signature numérique (doit correspondre exactement au « registrants name ») *

2026 Brampton Cup [Initiation Funbox Sparring Session]

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EMERGENCY CONTACT

Division