Project Fighting Chance Winter Boxing and Fitness Program

December 30th-January 10th ~1PM-4PM

K-12th grades

Registration Deadline December December 18th

Due to the program demand, waiting until the deadline to register may result in your child being placed on the waiting list.

Student (s) Information

Full Name

Birth Date +

Grade

Gender

Full Name

Birth Date +

Grade

Gender

Full Name

Birth Date +

Grade

Gender

Full Name

Birth Date +

Grade

Gender

School district your student(s) attends?

School your student(s) attends?

Household / Adult Primary Contact

Relationship to Participants: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

City *

State *

Zip *

Phone *

Email Address *

Enrollment Packet

Emergency Contact Information– Alternate Pickup/Release

First Name *

Last Name *

Work Phone Number *

Cellphone Number *

Relationship to Child *

Medical Release Information

Physician Name *

Health Insurance *

Policy Number *

Phone Number

Preferred Hospital

Additional children's medical information.

Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures).

Is your child(ren) presently being treated for an injury or sickness, or taking any form of medication for any reason? *

No

if Yes explain if Yes explain

Is your child(ren) allergic to any medication? *

No

if Yes explain if Yes explain

Meal and Snack Information

Is your child(ren) allergic to any type of food ? *

No

if Yes explain if Yes explain

Does your child require a special diet? *

No

if Yes explain if Yes explain

Liability Release and Parental Consent

Liability Release and Parental Consent Form *

I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to my child(ren) as a result of participation in said program. This release is intended to discharge in advance Project Fighting Chance and San Bernardino Unified School District and each organization's officials, officers, employees, volunteers, and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some experiential, academic, recreational, and fitness activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and risk assumption would be binding on my heirs and assignees.

Parental Consent *

I understand that I will be notified in the case of a medical emergency involving my child. If I cannot be reached, I authorize the calling of a doctor and the provision of necessary medical services if my child is injured or becomes ill. At this moment, I consent to have my child(ren)treated by emergency medical personnel, a physician, or a surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that the program will provide no medical insurance for such treatment and that the cost thereof will be at my expense. I have read and understood the initial registration liability release and parental consent form and agree to all its terms and conditions.

Photo Release *

I, with this, permit my child to be photographed during the PFC summer boxing fitness and enrichment. I understand the photos will be used to keep a journal of activities, to share during power point presentations and reports to our donors, and for promotional purposes, including flyers, brochures, newspapers, and the internet. I understand that although my child's photograph may be used for advertising, their identity will not be disclosed. I do not expect compensation; all photos are Project Fighting Chance's and its affiliate's property.

Transportation Release *

I hereby give permission for the transportation of my children to the official PFC Fieldtrip by modes of transportation agreed to by the camp organizers.

Check to receive camp information via email.

About Project Fighting Chance

P.F.C. is a comprehensive, year-round, free after-school enrichment program that includes its
signature and award-winning F.I.G.H.T.S. (Faith in God Heals Troubled Souls) Boxing
Program. Our mission is to reframe the life narrative of children and youth from “at-risk.”
to “future leaders” through after-school enrichment and youth development boxing
programs. P.F.C. earned the distinguished honor of being named the 2020 California
Nonprofit of the Year.

P.F.C.’s after-school enrichment programming incorporates evidenced-based practices,
mentorship, Social Emotional Learning, and Resiliency training. Projecting Fighting
Chance programs and services are culturally responsive and trauma-informed. The
F.I.G.H.T.S. Boxing Program has produced thirteen National Champions, two U.S.
Olympic Trial participants, an Olympic Team Alternate, and four Junior Olympic Gold
Medalists. P.F.C., since its inception in 1999, has provided services to more than six
Thousand children and youth.

For Questions, please call (909) 229-1956 or email simmons6197@gmail.com