New Jersey Association of USA Boxing
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Official Application for 2017 N.J. Association of USA Junior Olympic Boxing Championships
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REPRESENTING GYM:
Boxer's Name:
Home Address:
City:
State:
Zip Code:
Age:
Birth Date:
Telephone Number:
Number of Bouts:
Wins:
Losses:
Member ID #:
Select Division/Age/Weight:
Hold Harmless Agreement:
I HONESTLY STATE THAT I AM IN GOOD MEDICAL CONDITION AND HAVE MADE THE NJLBC PHYSICIAN AWARE OF ANY ILLNESS, INJURY, OR ANY OTHER SITUATION (EXTERNAL OR INTERNAL) THAT IS PRE-EXISTING BEFORE I ENTER THE NEW JERSEY STATE COMPETITION. OR, I WILL NOTIFY THE NJLBC OF ANY CHANGE OR INJURY THAT OCCURRED TO ME PRIOR TO PARTICIPATING IN ANY SHOW DURING THE PROGRESS OF THE TOURNAMENT.

I AGREE TO ABIDE BY THE RULES OF USA BOXING, AND UNDERSTAND THE RISK OF PARTICIPATION, THAT BOXING IS A CONTACT SPORT, AND THAT IT CARRIES THE RISK OF SERIOUS INJURY(S) THAT COULD BE PERMANENT OR FATAL. I KNOWINGLY ACCEPT, ASSUME, AND RECOGNIZE ALL RISK(S).

I FURTHER RELEASE AND PROMISE NOT TO SUE ANY MEMBER OF THE NEW JERSEY LBC, ITS OFFICERS, OFFICIALS, OR OTHER REPRESENTATIVE, ANY CLUB OPERATOR, SPONSOR, OR TOURNAMENT SITE OPERATOR FOR ANY ACCIDENT, DAMAGE, OR INJURY SUFFERED BY ME, WHETHER ARISING FROM NEGLIGENCE OR OTHERWISE, DURING MY PARTICIPATION IN THE NJLBC CHAMPIONSHIPS.

MY SIGNATURE BELOW (IF UNDER 18, THE SIGNATURE OF MY LEGAL GUARDIAN OR PARENT) SERVES AS AUTHORIZATION OF VOLUNTARY CONSENT AND RELEASE.
Athlete's Signature:
Date:
Parent/Guardian Name:
Parent/Guardian  Signature:
Date:
Coach/Manager's Name:
Phone:
E-mail address:
Fax #:
(Parent signature or Guardian signature above constitutes consent and 
approval for the Athlete's participation in this amateur event)

Please submit by August 28, 2016

MANDATORY qualifier for the road to the JO Regional & National tournaments.  

Male/Female::

10 Pearl Street, Long Branch, NJ 07740         Phone 732-768-4086 

Height:
Weight:
  • Youth Boxers must be 17 or 18 years of age, determined by year of birth (must be born in the year 1999 or 2000)
  • Junior Boxers must be 15 or 16 years of age, determined by year of birth (must be born in the year 2001 or 2002)
  • Intermediate Boxers must be 13 or 14 years of age, determined by year of birth (must be born in the year 2003 or 2004)
  • Bantam Boxers must be 11 or 12 years of age, determined by the year of birth (must be born in the year 2005 or 2006)
  • Pee Wee Boxers must be 8, 9 or 10 years of age, determined by the year of birth (must be born in the year 2007, 2008 or 2009)
Tournament Details:

*Sunday May 7th- Junior Olympic New Jersey State Tournament- at Gleason's Jersey Shore- 10 Pearl Street Long Branch, New Jersey, Weigh in 10-12 p.m. Boxing at 1 p.m.

*Saturday May 13th- Junior Olympic New Jersey vs. Metro NY Box Off- Gleason's Jersey Shore- 10 Pearl Street Long Branch, New Jersey.  Weigh in 2-3:30 p.m. 1st bout at 5 p.m.