Youth Boxing Enrollment

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Secure payment

Payment details are completed through a secure payment link or with the front desk. Card and bank data are never stored in this form.

Choose your OptionFirst Name (name of student)Last Name (name of student)Birthdate (student)Phone NumberE-Mail AddressYour Billing AddressPreferred way to contactEmergency Contact NameEmergency Contact Phone NumberTerms and Conditions I agree*You consent to receive communications from us electronically. We will communicate with you by e-mail, phone, and SMS. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing. All memberships that require a 12-month commitment will auto-renew at the end of the 12-month term to a month-to-month membership. All other memberships are month-to-month reocurring memberships, usage is defined by the membership type. A month-to-month membership requires 30-days written notice for cancellation. BOXSTL will provide the cancelation link that is required to be completed, BOXSTL staff will email or text this link upon request. Guests/members/students will fill out required membership information, signature is required and click submit. This will serve as guests/members/students 30 days written notice. Once completed, the membership will be set into cancel mode. There will be one final payment due within the next 30 days, this has already been auto-set by BOXSTL's payment system and will auto-pay on the regularly scheduled payment date. *Taxation by state may vary, price is displayed without tax (tax will be applied upon completion of purchase).Authorization I agree*I authorize * operating by license under BOXSTL, to initiate transfers, whether through my credit card company or EFT/ACH transfer, from the designated account indicated above for the purpose of paying, initial payment and on a recurring basis, all portion of the dues, fees and charges which I owe under this agreement. I also authorize BOXSTL, operating by license under BOXSTL, to initiate, if necessary, debit entries and adjustments for any credit entries made in error.Waiver I agreeActivities Release and Waiver of Liability:Notice: This form contains a release and waiver of liability and when signed is a contract between the undersigned participant and JB Athletic Club LLC DBA BOX STL with legal consequences. Please read this Agreement, carefully before signing your name at the bottom of the page. Date of Execution of Release and Waiver of Liability: The undersigned agrees that this “Activities Release and Waiver of Liability” form agreement is valid from the date of execution through the date of discharge. Acknowledgments and Representations by Client: The undersigned is currently a client of JB Athletic Club LLC DBA BOX STL . The undersigned has voluntarily consented to participate in voluntary sports activities or voluntary physical activities such as boxing, kickboxing and other such types of voluntary sports or physical activities, which may not be specifically identified herein, while being a client at such facility. The undersigned acknowledges and represents that their participation in such sports activities and physical activities is not a mandatory requirement of BOX STL , and that any participation by the undersigned in any and all sports related activities and physical activities, is purely voluntary and of the undersigned’s own free will. The undersigned acknowledges and represents that there has been no coercion or force on the part of BOXSTL for the undersigned to execute this release and waiver of liability agreement. The undersigned has knowingly, freely and voluntarily consented to execute this release and waiver of liability agreement. The undersigned acknowledges and understands that it is the undersigned’s sole decision to participate in such voluntary activities. The undersigned acknowledges and represents that he has been informed that he has an absolute right to refuse to participate in any and all sports related activities or physical activities. To JB Athletic Club LLC DBA BOX STL , Inc.: In consideration of the opportunity afforded to me, by BOX STL, to participate in voluntary sports activities or voluntary physical activities such as boxing, kickboxing and any other similar types of voluntary sports or physical activities which may not be specifically identified herein, the undersigned client freely agrees to make the following contractual representations and agreements with BOX STL. The undersigned client, does hereby knowingly, freely, and voluntarily assume all liability for any damage or injury that may occur as a result of my (or my dependent/ward) participation in the activities described herein and agree to release, waive, discharge, and covenant not to sue BOX STL, its officers, agents, employees, and volunteers from any and all liability or claims that may be sustained by me or a third party directly or indirectly in connection with, or arising out of participation in the activities described herein, whether caused in whole or in part by the negligence of JB Athletic Club LLC DBA BOX STL , or otherwise. The undersigned client, has read this form, fully understand its terms, and understand that, I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of any and all liability to the greatest extent allowed by law, and I agree that if any portion of this contract is held to be invalid the balance notwithstanding, shall continue in full legal force and effect. I also agree that the rules provided to me by the BOX STL will be followed during the course of my voluntary participation in the activities described herein. Otherwise, my privilege of participating in such activities will be revoked immediately. Each client must sign a release and waiver of liability form in order to participate in the voluntary activities described herein. I acknowledge that due to the nature of the activities described herein, BOXSTL staff will not be able to prevent injuries from occurring during the course of such activities; therefore, I am choosing to participate in such activities at my own risk and agree to assume all risks associated therewith. Indemnification of JB Athletic Club LLC DBA BOX STL : The undersigned client shall at all times hereafter indemnify, hold harmless and, at BOX STL Attorney’s option, defend or pay for an attorney selected by BOX STL to defend BOX STL , its officers, agents, servants, and employees against any and all claims, losses, liabilities, and expenditures of any kind, including attorney fees, court costs, and expenses, caused by negligent act or omission of the client, other clients, BOX STL , its employees, agents, servants, or officers, or accruing, resulting from, or related to the undersigned client engaging in any voluntary sports activities or voluntary physical activities such as boxing, kickboxing and any other similar types of voluntary sports or physical activities which may not be specifically identified herein, including, without limitation, any and all claims, demands, or causes of action of any nature whatsoever resulting from injuries or damages sustained by any person or property. The provisions of this section shall survive the expiration or earlier termination of this Agreement or the discharge of the client from the facility operated by BOX STL. Venue: This Agreement shall be interpreted and construed in accordance with and governed by the laws of the State of Missouri. Venue for litigation concerning this Agreement shall be in St. Louis County.Signature Parent/Guardian