Enroll in The Bloc
Thank you for your interest in joining The Bloc. This form is meant for parents and guardians of participants to indicate interest and permission. The Bloc is not a selective program. All Chicago students in grades 6-12 are eligible to join The Bloc. No other responses to this form will be used to select students.

We will follow up with a phone call to set up the first day of training.
Email address *
Student Name
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Student Email
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Parent Name(s)
Your answer
Parent Phone
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Student Phone
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Street Address
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Zip Code
Your answer
Sex
Age
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School
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Grade
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Height
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Weight
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Grade in 2019-2020 School Year
Your answer
Which facility is easiest to get to consistently?
The Bloc operates in 10-week sessions, with continued training for serious boxers between each session. Fighters MUST train at least twice/week AND attend Saturday sessions to stay in The Bloc. Which session(s) do you want to attend? These dates might shift due to the needs of each school. We'll follow-up to confirm.
Does The Bloc have permission to use photo, video, and audio for promotional purposes?
Is this participant in good health and in proper physical condition to participate in the The Bloc?
Health Notes (allergies, injuries, prescriptions)
Your answer
Please read the waiver and type your name as an electronic signature: I acknowledge and fully understand that each participant will be engaging in activities that involve risk of injury which might result not only from his/her own action, inaction or negligence, but also the action, inaction or negligence of others, the rules of play or the condition on the premises or of any equipment used. I release and forever discharge and hold harmless The Bloc and its successors and assigns from all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my training and volunteer work with The Bloc.
Your answer
Please have the participant answer the following question: Why do you want to join The Bloc?
Your answer
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