gleason's gym, 77 front st, brooklyn ny...

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6th ANNUAL TOURNAMENT HOSTED BY: GLEASON'S GYM, 77 FRONT ST, BROOKLYN NY 11201 Friday, 7/10/15 OPENING DAY Saturday, 7/11/15 PRELIMINARIES Friday, 7/17/15 QUARTER FINALS Saturday, 7/18/15 QUARTER FINALS Friday, 7/24/15 SEMI FINALS Saturday, 7/25/15 CHAMPIONSHIPS Friday, 7/31/15 SEMI FINALS Saturday, 8/01/15 CHAMPIONSHIPS Saturday, 8/08/15 CHAMPIONSHIPS SPONSORED BY: SANCTIONED BY: NEW YORK BOXING MGMT USA 82 WYCKOFF AVE. BOXING RIDGEWOOD, NY 11237 METROPOLITAN 929-234-5600 ASSOCIATION

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Page 1: GLEASON'S GYM, 77 FRONT ST, BROOKLYN NY 11201files.ctctcdn.com/f9b49886001/23740f7e-0b8e-45db-8091-a0af1223… · Olympic weights, 112, 132 & 165, for women. Weight classes: All weight

6th ANNUAL TOURNAMENT

HOSTED BY:

GLEASON'S GYM, 77 FRONT ST, BROOKLYN NY 11201

Friday, 7/10/15 – OPENING DAY Saturday, 7/11/15 – PRELIMINARIES Friday, 7/17/15 – QUARTER FINALS Saturday, 7/18/15 – QUARTER FINALS Friday, 7/24/15 – SEMI FINALS Saturday, 7/25/15 – CHAMPIONSHIPS

Friday, 7/31/15 – SEMI FINALS Saturday, 8/01/15 – CHAMPIONSHIPS Saturday, 8/08/15 – CHAMPIONSHIPS

SPONSORED BY: SANCTIONED BY: NEW YORK BOXING MGMT USA 82 WYCKOFF AVE. BOXING RIDGEWOOD, NY 11237 METROPOLITAN 929-234-5600 ASSOCIATION

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2015 New York Boxing Tournament

Fact Sheet

July 10,11,17,18,24,25,31

August 1 & 8 - 2015

Gleason's Gym Early Registration Deadline: Saturday, June 27, 2015 @ 1:00PM

Late Registration Deadline (late fee applies): Saturday, July 4, 2015 @ 1:00PM

Forms must be received (not postmarked) by above dates!

General Tournament Information The New York Boxing Tournament is a tournament open to all Juniors, Novices,

Open, Metro Elite*, Female and Master boxers. This tournament is open to all boxers regardless of state of residency. Winners of this tournament in the “Metro

Elite” division (defined later) will advance to the OLYMPIC TRIALS QUALIFIER II – September 5-12, Baltimore, MD. This will be the second qualifier for the Olympic Trials for Men's Boxing and the final qualifier for the Olympic Trials for Women's

Boxing. Metro Elite boxers and regular Open boxers will box off in their respective divisions and champions will box for championship belts.

Divisions & Class Information Divisions:(Novice, Open - all divisions)

Master (Male & Female) - (1.5 min x 3rds) 35+ - ? Yrs old

Metro Elite Male Open* - (3min x 3rds) 19 – 39 yrs old Male Open - (3min x 3rds) 17 – 34 yrs old Male Novice - (2min x 3rds) 17 – 34 yrs old

Metro Elite Female Open* - (2min x 4rds) 19 – 39 yrs old Senior Female Open - (2min x 4rds) 17 – 34 yrs old

Junior (Open- Novice) - (2min x 3rds) 15 – 16 yrs old Intermediate (Open- Novice) - (1.5 min x 3rds) 13 – 14 yrs old Bantam (Open- Novice) - (1min x 3rds) 11 – 12 yrs old

Pee Wee (Open- Novice) - (1min x 3rds) 08 – 10 yrs old *Metro Elite boxers are from Metro, who are U.S. Citizens and have boxed in the Metros, Golden Gloves in Metro, etc. and represented Clubs in Metro

in the year prior to the start of this tournament. Olympic weights, 112, 132 & 165, for women.

Weight classes: All weight classes are to be determined according to USA Boxing rules.

Boxers must weigh in day of bouts and will have no weight allowance. Boxers who do not make weight on day of competition will be disqualified from tournament. Weight class changes will be allowed up until 7/4/15

provided there is availability in the new weight class. Any changes in weight class must be confirmed in writing via text or e-mail and must be

done exclusively with the tournament director.

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Sanction Tournament held under the sanction of USA Boxing, Metropolitan Association.

Governance Tournament Director will be Ray Cuadrado, [email protected], who will

preside over tournament in conjunction with the Board of Directors of USA Boxing Metropolitan thereby forming tournament committee. In the event Board members are not present Director shall recruit volunteer officials and coaches to resolve

matters of dispute or concern.

Awards Championship Belts and medallions will be awarded in all age levels in which bouts are contested. There will be no uncontested champions. Divisions must

have a minimum of 4 boxers to contest division. The Head Coach with the most champions will be awarded with Team trophy.

Competition Dates

Friday July 10, Saturday July 11, Friday July 17, Saturday July 18, Friday July

24, Saturday July 25, July 31, August 1 & August 8. If you are planning to compete in another tournament, Junior Olympians, Novices, Masters and non-Olympic weight women only must state so on your entry form for scheduling

purposes. Elite and Senior Open Male and Female boxers will not have this option and must be available for entirety of tournament.

Event Location Preliminaries – Championship Finals to be held at Gleason's Gym, 77 Front St., Brooklyn NY 11201. (Venue and dates subject to change if necessary.)

USA Boxing Membership Each tournament participant (Boxers, Coaches, Officials, Physicians, Tournament Administration, etc.) must be registered with USA Boxing for the 2015 membership year, and have proof of registration (Athlete, Coach or

Officials passbook with Passbook Validation Label). Coaches and Officials must be currently certified.

Age Determination In accordance with USA Boxing Rules ALL athletes will compete in their

age category according to year of birth. Example: athletes born in the years 1999 -2000 are 15 -16. Athletes born in 1998 are 17 years old and will compete as seniors.

Registration

Early Registration can take place by MAKING SURE completed application with fee (made payable to NY Boxing Mgmt.) IS DELIVERED to the Brotherhood Boxing Club, 82 Wyckoff Ave., Ridgewood NY 11237 by Saturday, June 27 from 10:00 a.m. - 1:00 p.m. There will be an area set up for the NY Boxing Tournament staff to verify all participants’ information on tournament applications. You must provide current passbook registration number in order to participate. NO BOOK… NO BOX!!!

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Late Registration may be accepted on a case by case basis provided late fee (additional $10.00) is included with entry form and there is room in the division applied for. Fees for applicants not accepted or in divisions uncontested will be refunded in full. After 7/5/15 all entry fees are non-refundable except for documented medical exceptions subject to a $10 processing fee for entries in divisions that are contested.

Entry Fee The early application (received by 6/27/15) fee is:

$15 for Junior Olympians (8-16 in 2015) $20 for Novice Senior boxers (17-39 in 2015) $25 for Open Senior boxers (17-39 in 2015)

$75 for Master boxers (35+ in 2015)

Entries received after 6/27/15 will be assessed an additional $10 late fee.

Athlete Entry: All Athletes must turn in the following forms to complete the registration

process: Athlete Entry Form USA Boxing Code of Conduct

Medical Treatment Form Female Acknowledgement Form (females only)

Braces Release Form (if applicable) Breast Implant Form (if applicable)

It is important that all forms are completed and signed by the participant (and their parent and/or guardian if they are under the age of 18).

Coaches Entry: Coaches must be both a current registered and certified coach through USA Boxing in order to work their athlete(s) corner. Please contact your

LBC if you need to update your registration and/or certification. Coaches are now required by USA Boxing to obtain a coach’s passbook, which

contain proof of registration and certification. Coaches whose boxers are scheduled to box must show and submit books upon entry to every club or venue hosting a show during this tournament. Only two qualified coaches per

boxer will be allowed to enter at the weigh-in free of charge. All cornermen must be at least 18 yrs.

Officials Entry:

All registered and certified officials are welcome. If you wish to officiate please

contact Metro COO Michael O'Connor at [email protected].

Entry Limitations Participation in this tournament is by completed & paid registration only. All

individual boxers as well as team coaches are welcome to participate. The tournament director reserves the right to limit the number of entries for each team and/or weight class in each division in order to conclude the tournament by set

dates on a first come, first serve basis. All weight classes are to be in accordance to USA Boxing rules.

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Weigh-ins & Physicals

Only boxers scheduled to box are required to report to weigh-ins. Coaches will

not be allowed to approach the scale. On Fridays weigh-in will be 530pm-7pm only, on Saturdays weigh-in will be 4pm-530pm only. The boxer will only be

allowed one chance to make his weight during each weigh-in but unlimited use of the trial scale will be available for use during the weigh-in.

Tournament Draw The draw will take place immediately following the Weigh-ins/Physicals on the day of competition for that weight division. Empty brackets will be posted by opening day of the tournament on www.usaboxingmetro.com and on

https://www.facebook.com/pages/New-York-Boxing-Tournament/362842310446366

Conduct & Discipline All participants must adhere to the NY Boxing & USA Boxing Code of Conduct, which must be signed and turned in upon event registration. Individuals deemed guilty of misconduct will be immediately barred from all tournament facilities and

required to leave at their own expense and subject to further disciplinary action. Tournament Director, Chief of Officials and highest ranking Coach’s Committee

member will serve at each show as Judicial Committee to deal with emergency grievance and disciplinary process.

Boxers Equipment & Attire The New York Boxing Tournament will provide gloves for competition and tank top for finalists only. All other items (Hand wraps, foul-proof cups, breast protectors, form-fitted mouthpieces, uniforms, sponges, towels, clear water bottles,

etc.) must be provided by the participants. Mouthpiece – All boxers are required to provide their own individually

fitted mouthpiece in accordance to USA Boxing rules. New rules prohibit red mouthpiece or any red coloring on mouthpiece.

Headgear & No-foul protector – All boxers are required to provide their

own individually fitted headgear in accordance to USA Boxing rules. Male boxers are required to wear USA Boxing approved no-foul protectors. Only Metro Elite males & females are required to box with open face headgear.

Boxing Apparel – Boxers will be allowed to wear their own personalized trunks and "form fitting tank" during preliminary competition in accordance to USA

Boxing rules. The boxer’s legal name and registered boxing club logo are permitted. Boxer cannot have tape on any part of uniform.

Grooming – Boxers must be CLEAN SHAVEN before the weigh-ins. A neatly

trimmed mustache is no longer permissible. Sideburns are not

permitted to extend below the earlobe. Boxers who do not report to the

weigh-ins groomed as required will be denied permission to weigh-in. Hair

nets are mandatory for any boxer with long hair. Hand wraps – Tape and gauze may be used at your own expense;

none will be provided. Velpeau hand wraps are acceptable but must conform to USA Boxing rule on hand wraps.

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NEW YORK BOXING TOURNAMENT 2015 Athlete Entry Form Please Print or Type All Information – APPLICATION MUST BE COMPLETE! (Failure to provide accurate info, working phone numbers and e-mail will interfere with tournament notification process and disqualify boxer from tournament.)

BOXER

First Name____________________________ Last Name _______________________________ M.I. _____

Address ________________________________City ____________________State _____Zip Code __________

Home/work ( ) _______-_________ Cell ( ) ______- _________ E-mail:_________________________

Date of Birth: ____/____/____ Age _____ *NOTE: IF YOU WILL BE 17 BEFORE 12/31/15, YOU ARE NOT A J.O.

USA Boxing Registration #: __ __ ____ US Citizen Yes__ No__ Male__ Female__ Record: W___ L ___

Club ___________________________________ Gym Telephone ( ) _______-___________

1. 1ST Coach _____________________________ Coach Telephone ( ) _______-__________

USA Boxing Registration Number: __ __ __ __ __ E-mail:________________________________

2. 2nd Coach ______________________________ Coach Telephone ( ) _______-__________

USA Boxing Registration Number: __ __ __ __ __ E-mail:________________________________

CLASSIFICATION OF BOXERS:

(Minimum of 4 boxers required to contest a division) NO WEIGHT ALLOWANCES

Junior Olympic age divisions:

Pee Wee (Ages 8-10; Born in 2005, 06, 07): ___ Bantam (Ages 11-12; Born in 2003 & 2004): ___

Intermediate (Ages 13-14; Born in 2001 & 2002): ___ Junior (Ages 15-16; Born in 1999 & 2000): ___

Weight Class (check one): 50___60___ 65___ 70___75___ 80___ 85___ 90___ 95___ 101___ 106___

110___114___ 119___ 125___132___ 138___ 145___ 154___ 165___ 176___176+___

Men: (17-39) Novice ___ Open ___ Metro Elite(Open Face Headgear)___ Master (35+) ___:

WEIGHT CLASS (check one): 114___ 123___ 132___ 141___ 152___ 165___ 178___ 201___ 201+___

Women: (17-39) Open___ Metro Elite(Open Face Headgear)___ Master (35+) ___: *

WEIGHT CLASS (check one): 106 __ 112 __ 119 __ 125 __ 132 __ 141 __ 152 __ 165 __ 178 __ 178+ __

*WOMEN MUST SIGN AND ATTACH THE “FEMALE ACKNOWLEDGEMENT” FORM

IF ENTRANT IS UNDER 18 YEARS OF AGE, HE/SHE MUST HAVE THE CONSENT OF PARENT OR GUARDIAN, WHO MUST EXECUTE THE CONSENT ON THE REVERSE SIDE.

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WAIVER/WARNING/DISCLAIMER

In consideration of your acceptance of this entry to participate in the 5th Annual New York Boxing Tournament and activities connected to same, I hereby, for myself, my heirs, executors, administrators and assigns and personal representatives waive and release any and all right to any claim for damages I may or might have against USA Boxing, Inc. and USA Boxing, Metropolitan Association, New York Boxing Management Corp, sponsors and venue owners of this event or the officers, members, employees, subcommittees, agents, representatives and assigns of these entities, for any injury or damages suffered by me, or my child, whether arising from the negligence of the releases or otherwise, all claims, actions, suits, proceedings, costs, expenses, damages and liabilities arising out of, compile with or resulting from, my or my child’s participation in the 4th Annual New York Boxing Tournament, including, without limitation, any injuries or damages, and or arising from traveling to and/or returning from the New York Boxing Tournament.

I agree for myself and my heirs, distributes, guardians, legal representatives, and assigns that in the event that any claims for personal injury, death, or property damage shall be prosecuted against the New York Boxing Management Corp., USA Boxing, Metropolitan Association or USA Boxing their members, officers, employees, or agents, I shall indemnify and hold harmless the New York Boxing Management Corp, Metro Association or United States Amateur Boxing their members, officers, employees, or agents from any and all such claims or causes of action by whoever made and wherever presented.

I agree to abide by the rules of the United States Amateur Boxing. If I observe any unusual, significant violations or hazards during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. I fully understand that I assume all responsibility for any injury or damage that I may incur in these boxing bouts. I understand and agree that medical or other services rendered to me by or at the insistence of any of the named parties are not an admission of liability to provide or continue to provide any such services and is not a waiver by any of said parties of any right or rights hereunder.

I certify that I have no injuries to my hands, neither fractures nor broken bones, within three (3) years preceding the dates of this entry form, and know of no other injuries to the head, concussion, fainting spells, and will notify boxing officials immediately should any of these injuries and conditions be experienced in the future.

In addition, I also understand and appreciate that participation in sports carries a risk to me of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept, and assume this risk.

I, as a member of the United States Amateur Boxing (USA Boxing), understand and must comply with the guidelines as set forth in USA Boxing’s Code of Conduct. I understand that this Code of Conduct applies to any and all athlete and non-athlete members of USA Boxing while participating in USA Boxing sponsored activities. I also understand any and all athlete and non-athlete members are required to abide by this Code of Conduct and all United States Olympic Committee policies, rules and regulations. By signing this code of Conduct, I acknowledge that I have previously read it, understand it and am willing to accept the conditions as outlined in it. I also acknowledge and accept the consequences and disciplinary procedures that could be enforced if I violate any of the codes. I have read all tournament literature and accept terms. X Signature of Participant: ____________________________Print: __________________________ Date____/____/____ X Signature of Parent ________________________________Print: __________________________ Date____/____/____

(or Legal Guardian if under 18 yrs of age)

X Coach's Signature: ________________________________Print: __________________________ Date____/____/____

Application Process and Fees – All forms and applications must be completed for registration to be accepted. Forms can be submitted in person at New York Boxing, 82 Wyckoff Ave, Ridgewood NY 11237 from 3:00 pm to 8:00 pm Monday thru Friday OR via mail and but must be received by 6/27/15. Saturday 6/27/15 registrations will be accepted in person from 10am to 1pm and will be considered timely. The early application fee is $15.00 for Junior Olympians, $20.00 for Novice , $25.00 for Open and $75.00 for Masters. Any entries received after 6/27/15 will incur an additional $10.00 late fee. Saturday 7/4/15 late registrations will be accepted in person from 10am to 1pm only. Applications will not be accepted after 7/4/15. NO EXCEPTIONS! Cash or money orders will be accepted for in-person registration days. Application fees are non-refundable for those with boxers in their divisions, who no-show or fail to make weight but refundable for those that withdraw prior to 7/5/15 and who are in uncontested divisions. Make money orders payable to: New York Boxing Mgmt. Are you planning to compete in any other tournaments during July/August? ______________________________________ Tournament Name/Dates (Women will start 2nd week, Open Seniors will not be accommodated to compete at Ringside)

Send entries to: New York Boxing Mgmt., PO Box 370 092, Ridgewood, NY 11237, 929-234-5600

Entries received by: 6/27/15 will be considered timely. Entries received after: 6/27/15 will be considered late. Late entries are subject to an additional $10. late fee if accepted. NO EXCEPTIONS!

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United States Amateur Boxing Inc.

Female Athlete Acknowledgement

Name of Event__________________ Date___________Sanction #_______

Sanctioned by_____________________ and United States Amateur Boxing

(Section above to be completed by Sanction Holder)

Must be completed and signed by female athletes each time they compete.

Name:______________________________ LBC Name & #______________________

Address_________________________________________________________________ Street City Zip Code

Birth date______________________ USA Boxing Registration #___________________

Acknowledgement I CERTIFY THAT I AM NOT PREGNANT, NOR DO I HAVE ANY PAINFUL PELVIC DISCOMFORT SUCH AS SYMPTOMATIC ENDOMETRIOSIS OR OTHER CAUSES, ABNORMAL VAGINAL BLEEDING OF UNDETERMINED CAUSES (ETIOLOGY), RECENT LOSS OF MENSTRUAL PERIOD (SECONDARY AMENORRHEA), RECENT BREAST BLEEDING, RECENTLY DEVELOPED BREAST MASS, RECENT BREAST DYSFUNCTION PREVIOUSLY NOT PRESENT OR SURGICAL BREAST IMPLANTS, AND HAVE READ SECTION 101.9(4) OF USA BOXING’S OFFICIAL RULES PERTAINING TO MY PRESENT PHYSICAL CONDITION. I FURTHER AGREE THAT I WILL IMMEDIATELY NOTIFY MY COACH, TRAINER OR OTHER LOCAL BOXING OFFICALS IF ANY OF THE ABOVE DESCRIBED CONDITIONS SHOULD DEVELOP/APPLY.

(SECTION 101.9(4) OF USA BOXING’S OFFICIAL RULES IS INCORPORATED IN THIS ACKNOWLEDGEMENT BY

REFERENCE).

I, the undersigned, have read this Acknowledgement.

Signed_____________________________________________ Date_____________________________ (Participant’s Full Name)

Signed_____________________________________________ Date_____________________________ (Participant’s Legal Guardian) *REQUIRED IF ATHLETE IS A MINOR

12/2004

This Form may be reproduced

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USA Boxing, Inc. 2014 NEW YORK BOXING TOURNAMENT

Release to Compete With Braces USA Boxing Rule 102.6 (4) (g) Boxers who wish to compete with braces are required to have attached to their passbooks a completed Release To Compete With Braces form. This form requires the written approval of their dentist, parents and/or guardian (if under 18 years of age) and a dentist-molded mouthpiece. This includes upper and/or lower braces. Boxers competing with braces waive the right to dental coverage under the USA Boxing insurance program.

I understand the above rule and give my permission for to compete in amateur boxing. (Boxer’s name)

Dentist Approval:

Print Name Signature

Date State License Number

Parent or Legal Guardian Approval (if boxer is a minor):

Print Name Signature Date

Athlete:

Print Name Signature Date

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Athlete/Non-Athlete Code of Conduct

Outlined below is the USA Boxing Code of Conduct

I understand that my compliance with the Code is a requirement for my participation in USA Boxing events. I recognize that my participation in this event is an honor. I also recognize that this Code does

not establish a complete set of rules that prescribes every aspect of appropriate behavior. Further, I:

1. Will act in a manner consistent with the spirit of fair play and responsible conduct;

2. Will recognize, respect and adhere to the authority of USA Boxing’s appointed coaches and team leaders;

3. Will attend and arrive at all team functions a minimum of 5 minutes prior to the scheduled start, to include meetings, practices, press conferences, competitions, etc. unless excused or otherwise instructed by the team leader or USA Boxing’s designee;

4. Will comply with USA Boxing and the New York Boxing Tournament (NYBT) uniform requirements;

5. Will adhere to all curfews established by the team leader or USA Boxing’s designee;

6. Will not commit a doping violation as defined by the International Olympic Committee (IOC), Association International de Boxe Amateur (AIBA), World Anti-Doping Agency (WADA), the United States Anti-Doping Agency (USADA), or the United States Olympic Committee (USOC) rules;

7. Will abide by the policies and rules established by USA Boxing and NYBT;

8. Will respect others, including my teammates, coaches, competitors, officials and spectators;

9. Will not engage in, nor tolerate, any form of verbal, physical or sexual abuse;

10. Will respect the property of others;

11. Will refrain from profanity and derogatory language that would reflect negatively on myself and USA Boxing;

12. Will refrain from illegal or inappropriate behavior that would detract from a positive image of myself and USA Boxing;

13. Will refrain from engaging in any behavior that could detract from my ability, or my teammates’ ability, to perform optimally;

14. Will cooperate with USA Boxing’s grievance process and Judicial Committee requests.

Any member present during any violation of the Code of Conduct should leave the area immediately or be considered a participant by choice.

Disciplinary Procedures and Penalties Failure to comply with the Code of Conduct set forth in this document for USA Boxing may result in disciplinary action

in accordance with the penalties outlined in this agreement.

Penalties could include:

1. Temporary or permanent termination of USA Boxing membership.

2. Suspension from USA Boxing activities for a specified period.

Following any proposed disciplinary action by USA Boxing against a member, the member has a right to a hearing by the

Judicial Committee, if requested in the statute of limitations and submitted with the filing fee.

Any appeal taken for disciplinary action rendered in an emergency hearing shall be to USA Boxing’s CEO and will be

conducted in accordance with Article XVI, of USA Boxing’s 2015 revised Constitution and By-laws.

Acceptance

I pledge to uphold the spirit of this Code, which offers a general guide to my conduct as a participant in

a USA Boxing event. I agree to follow the USA Boxing Grievance Procedures if I am charged with violation of the Code. I have familiarized myself with the Code and understand that my acceptance of it, as signified by my signature below, is a condition of my membership in this USA Boxing event.

Participant Name (Printed) Date

Participant Name (Signature)

Name of Event

Witness

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MEDICAL TREATMENT FORM

TO: 2015 New York Boxing Tournament Participants

FROM: New York Boxing Management

SUBJECT: Medical Treatment Form

United States Amateur Boxing’s insurance company requires a signed medical treatment form either

authorizing emergency medical treatment or not authorizing medical treatment for all participating

individuals. Participants under 18 years of age, are required to have parental / guardian

signatures as well. Please complete and sign the attached form. Be sure to indicate whether treatment is approved or not approved.

Thank you for your assistance with this matter. Please do not hesitate to contact the Events Department at New York Boxing Headquarters at (929) 234-5600 if you have any questions.

MEDICAL TREATMENT FORM

I AUTHORIZE a duly appointed representative of United States Amateur Boxing, Inc., to consent to emergency medical treatment during my participation in USA Boxing’s sanctioned event.

I DECLINE to authorize consent for emergency medical treatment during my participation in USA Boxing’s sanctioned event for the following reasons:

If you marked DECLINE, please mark one of the following:

Religious

Personal

Other:

Signed: Date:

(Athlete Signature)

Signed: Date:

(Parent/Guardian Signature for athletes under 18 yrs.)

Rev.04/18/13 FORM MUST BE FILLED OUT IN ITS ENTIRETY

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USA Boxing, Inc.

Release To Compete With Breast Implants Boxers who wish to compete with breast implants are required to have attached to their passbooks a completed Release To Compete With Breast Implants form. This form requires the written approval of their plastic surgeon, their primary care provider and, parent and/or guardian (if under 18 years of age). Boxers competing with breast implants will not be covered under the USA Boxing insurance program for damage to the implants, replacement of same or

injury occurring from such damage.

I understand the above rule and give my permission for to compete in amateur boxing. (Boxer’s name)

Plastic Surgeon Approval:

Print Name Signature

Date State License Number

Primary Care Physician Approval:

Print Name Signature

Date State License Number

Parent or Legal Guardian Approval (if boxer is a minor):

Print Name Signature Date

Athlete:

Print Name Signature Date

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BOXER “MUST HAVE” ITEMS

1. USA BOXING COMPETITION PASSBOOK

2. 2015 TOURNAMENT ENTRY FORM

3. ATHLETE ENTRY FORM

4. CODE OF CONDUCT

5. MEDICAL TREATMENT FORM

6. FEMALE ACKNOWLEDGEMENT FORM (FEMALES ONLY)

7. BRACES RELEASE FORM (IF APPLICABLE)

8. BREAST IMPLANT FORM (IF APPLICABLE)

9. ENTRY FEE

$15 for Junior Olympians (8-16 in 2015) $20 for Novice Senior boxers (17-39 in 2015)

$25 for Elite & Open Senior boxers (17-39 in 2015) $75 for Master boxers (40+ in 2015) Late Fee (if applicable) $10.00

10. BOXING EQUIPMENT-USA Boxing approved Headgear & Groin protector, Mouthguard (no red),

Uniform, Boxing Boots, Gauze/Tape or Velpeau

COACHES “MUST HAVE” ITEMS

1. USA BOXING RED COACH’S PASSBOOK-Current Membership and Certification

2. CORNERMAN SUPPLIES-Gauze/Tape, Scissors, Towel, Vaseline, Water in CLEAR bottle.