Saturday CHAMPS Program Application

Thank you for your interest in joining CHAMPSDen Boxing Club! Our program is designed to help young people build confidence, discipline, and life skills through boxing, mentorship, and positive community engagement.

Please complete the form below with the help of a parent or guardian.

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Name (Last, First) *
Address, City, State, Zip *
Phone *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Grade *
Parent Guardian Information (Last Name, First Name, Address and Phone) *
Emergency Contact (If Different from Above) *
If yes, please describe
Health Providers Name & Phone *
How did you hear about CHAMPSDen *
Which programs are you interested in? (check all that apply):   *
Required

CHAMPSDen programs are built on consistency and respect. Students are expected to attend scheduled sessions, follow coach directions, and demonstrate positive behavior at all times. I understand and agree to follow all CHAMPSDen rules and expectations.

 *
Student Signature *
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