Charter Oak Boxing Academy Enrollment Agreement

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Participant's First & Last Name *

Participant's Date of Birth *

YYYY

Participant's Gender *

Male

Female

Transgender (Male to Female)

Transgender (Female to Male)

Non-Binary/Non-Conforming

Unsure

Prefer not to self-identify

Other:

Participant's Preferred Pronouns *

He/Him/His

She/Her/Hers

They/Them/Theirs

Other:

Participant's Race *

White

Black/African American

American Indian/Alaska Native

Asian

Native Hawaiian/Other Pacific Islander

Middle Eastern

Prefer not to answer

Other:

Participant's Full Home Address *

Participant's Phone Number *

Participant's Email Address *

Participant's School Name *

Town/City where school is located *

Participant's Current Grade *

Participant's State assigned student identifier (SASID)

(Listed on school report card)

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