Gulf Coast National Championship

What: Gulf Coast National Championship

When: July 6-8, 2018

Where: Houston Boxing Gym, 11718 McGallion Rd, Houston, TX 77076

To All Boxing Clubs, Coaches and Boxers:

If you would like for your boxer to enter the Gulf Coast National Championship this year, you must have the Entry Form

completed and emailed, mailed or dropped off of Houston Boxing Gym by June 30th, 2018. Please DO NOT FAX!!!!

Open boxers will receive belts and Novice will receive medals.

____________________________________________________________________________________________________

Age Determination:

All weigh-ins will be at Houston Boxing Gym at 11718 McGallion Rd, Houston, Tx 77076

Trial Scale will be open from 7am – 8am on Friday, Saturday and Sunday.

Friday, July 6, 2018 weigh-ins will be from 8am to 10am. Doors will open at 4pm and boxing will begin at 5:00

pm.

Saturday, July 7, 2018 weigh-ins will be from 8am to 10am. Doors will open at 12pm and boxing will begin at

1:00pm.

Sunday, July 8, 2018 weigh-ins will be from 8am to 10am. Doors will be open at 12pm and boxing will begin at

1:00 pm.

No weight allowances given, boxers must be on weight.

_________________________________________________________________________________________

3 coaches allowed per team, you must have your red book in hand with registration for 2018.

ATHLETE

DOCUMENTATION

REQUIRED

All Athletes must print the following forms and present them at Houston Boxing Gym on

registration day (DO NOT MAIL OR FAX THESE FORMS):

USA Boxing Competition Passbook with current, valid Registration

Physical/Fit to Box Form (must be dated 2017 or 2018)

Declaration of Non-Pregnancy Form (all female athletes)

Release to Compete with Braces (if applicable)

Release to Compete with Breast Implants Form (if applicable, females only)

It is important that all forms are completed and signed by the participant and their

parent and/or guardian.

Gulf Coast National Championship

1. Entry form can be mailed, emailed or dropped off:

Email to: nc31900@gmail.com or mail or drop off at Houston Boxing Gym

11718 McGallion Rd, Houston, Tx 77079

Please print names and information clearly!

2. Competitors’ List- from youngest to oldest

Admission: Adults $15, Children (5-11) $10, Children 4 & under Free. These are prices per show.

We do request that you please share the tournament information with other gyms, coaches and boxers. If you have

any questions please contact: Baldomero Fernandez at (832) 545-2223 or Nataly Chavez (346) 414-1022.

Thank you in advance for your cooperation with the tournament information!

Baldomero Fernandez

Houston Boxing Gym Owner

11718 McGallion Rd

Houston, Tx 77079

(832) 545-2223

Nc31900@gmail.com

baldomerofernandez90@gmail.com

Gulf Coast National Championship

Competition List

Team: Phone:

Date:

Coaches:

**** Complete one for females and one for males******

Boxers Name Age Date Of

Birth

Weight Division

Only 3 coaches per team, all coaches’ names must appear in the space listed above. We will have a list of

coaches that will attend the tournament, all others will have to pay the entry fee, no Exceptions.

Gulf Coast National Championship

Gulf Coast National Championship

Boxer’s Official Entry Form

(Must be completed by each boxer before competition)

Waiver/Warning/Disclaimer

In consideration of your accepting this entry, I hereby, for myself, my heirs, executors, administrators and assigns waive and release all

rights to any claim for damages I may or might have against United States Amateur Boxing (USA Boxing) or Gulf Association. Any

sanctioning Local Boxing Committees of USA Boxing and all sponsors and venue owners, or the officers, sub-committees, agents,

representatives and assigns of these entities, for any injury or damage suffered by me, whether arising from the negligence of the releases

or otherwise, during my participation the boxing event listed below.

Event: Gulf Coast National Championship

Location: 11718 McGallion Rd, Houston, TX 77079

Date: July 6-8, 2018

I agree to abide by the rules of United States Amateur Boxing. If I observe any 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 bouts. I understand and agree that medical or other

services rendered to me by or at the insistence of any of said parties in 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 months preceding the dates of this entry

form, and know of no other injuries to the head, concussion, fainting spells, and will notify boxing official immediately should any of

these injuries and conditions be experienced in the future.

In addition, I also understand and appreciate that participation in sport carries a risk to me of serious injury, including permanent paralysis

or death. I voluntarily and knowingly recognize and assume this risk.

Boxer’s s Name (Print):

USA Boxing Validation #:

Contestant’s Address: City: Zip:

Date of Birth: Age: Telephone #:

Parent or Guardian Signature: Email:

Coach’s Name (Print): Telephone #:

Club Team:

Age and Division look back at the Chart on previous page. That will determine what the boxer age and division they

will compete. Please use the chart, when filling out the rest of the form.

Division: Weight Class:

10 or more Bouts, boxers are considered Open, under 10 will consider Novice!

Number of bouts: This tournament will be treated as a national tournament, there will NOT be

any matches. Weights will be enforced, no weight allowances!

Gulf Coast National Championship

Declaration of NON-PREGNANCY for Women boxers Aged 18 and Older

Date:

Place:

Name of Competition:

I declare that I am not pregnant.

I understand the seriousness of this statement and accept full responsibility for it. In the case that

this declaration is subsequently shown to be inaccurate or untrue and I suffer any related injury or

damage during the competition, I on behalf of myself, my heirs, executors and administrators,

waive and release all claims for damages I may have against USA Boxing (including its officials

and employees), the organizers of the competition (including the organizing committee and/or the

host federation) and the competition venue owners for such injury or damage.

Signature of the Boxer

Declaration of NON-PREGNANCY for Girls boxers aged Under 18

Date:

Place:

Name of Competition:

I, am one of the parents/ legal caretaker of

(insert name of Boxer)

and declare, on her behalf, that she is not pregnant. I understand the seriousness of this statement and accept full

responsibility for it. In the case that this declaration is subsequently shown to be accurate or untrue and

(insert boxers name) suffers any related injury or damage during the competition, I on

behalf of (insert boxers name), her heirs, executors and administrations, waive and release

any and all claims for damages she may have against USA Boxing (including its officials and employees), the

organizers of the competition (including the organizing committee and the host federation) and the competition

venue owners for such injury or damage.

Signature of one of the Parents/ Legal Caretaker

Acknowledged by: ____________________________________ (Signature of the Boxer)