Metro Detroit Golden Gloves Championships Official Entry Form

Name__________________________________________________ Ph. # __________________________

Address _______________________________________________________________________________

Age on 1st day of DGGT ______ Date of Birth___/___/___ Coach Name & Ph. ______________________  

USA Boxing # _____________________________Club Name __________________________________

Male Open (18-40) Circle Wt. - 112 - 125 - 132 - 139 - 147 - 156 - 165 - 176 - 203 - 203+
Fe-Male Open (18-40) Circle Wt. - 106 - 114 - 125 - 132 - 139 - 146 - 154 - 165 - 178 - 178+
Youth Male (17-18) Circle Wt. 106 - 112 - 119 - 125 - 132 - 139 - 147 - 156 - 165 - 176 - 189 - 203 - 203+
Youth Fe-male (17-18) Circle Wt. 106 - 110 - 115 - 119 - 125 - 132 - 139 - 146 - 154 - 165 - 178 - 178+
        Sub Novice =  0 – 4                     Novice =  5 - 10                       Open = 11 & over 
Boxers 8 - 16 - 101 & under 5 lb. increments - 8 thru 16 per USA Boxing competition weights.   
106-110-114-119-125-132-138-145-154-165-176- 176+    CHECK WEIGHTS WITH USAB RULES
Over maximum weight  -  All age divisions see Appendix ”F” USAB Rulebook 
8 - 16 boxers indicate competition Wt. _____lbs.   Division (C) (B) (A) ____ Rec - W _____L_______   
Prep age class  -  Pee Wee (8-9-10) - Bantam (11-12) - Intermediate (13-14)  -  JR age class (15-16)
                                     
Ages 17-40 - Sub Nov (0-4)  Nov (5-10)  Open (11 & over)  Rec W___ L___MMA Sanctioned Fights __
A boxer must be 18 years old, on the first day of the “DGGT Tournament” but not 41 years old on the first day of the National Golden Gloves Tournament.  
A.	Eligibility of Amateur Combat Sports Waiver – See USA Boxing Rulebook – Rule # 8.2 
B.	Request for Religious Exemption Waiver – See USA Boxing Rulebook – Rule # 9.2
C.	Boxers must present any “USA Boxing Approved Wavier” with their passbook.       
In consideration  of your accepting this entry, I hereby, for myself, my heirs, accessors, administrators and assigns waive and release any and all rights to any claim or claims I may or might have against United States Amateur Boxing (USA Boxing), USA Boxing Michigan Association, Metro Detroit Golden Gloves, Golden Gloves Assoc. of America and all sponsors, venue owner, or the officers, sub-committees, agents, representative and assigns of any of these entities, for any injure or damage suffered by me during my participation in, and or arising from traveling to and or returning from the completion to which this entry form applies or any subsequent advancing tournament related thereto.

I understand that physician (s) giving physicals for this competition are doing so to determine the individual’s fitness to engage in competitive sports.  That they are not necessarily performing a complete physical examination and are not liable for civil damages as a result of sets or omissions by performing the examination, except acts or omissions to gross negligence or willful and blatant misconduct or which are outside the scope of the license held by physician(s).

I further hereby authorize competent medical physicians to furnish such medical and surgical treatment including anesthesia to me considered necessary and proper in the treatment of myself.  It is also understood that this authorizes the hospital of the physician’s choice should it to deemed necessary that I should receive treatment at the hospital.  

I understand and agree that any medical or other services rendered to me by or at the instance 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 herein. 

I certify that I am in good physical condition, that I have had no head injuries or illness that I have sustained which may reoccur and be detrimental to my participation in this competition. 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 also certify that I am an amateur athlete currently registered with and in good standing with USA Boxing.  I will abide by all rules of the Golden Gloves Tournament, the rules of USA Boxing and the rules of fair play, which normally govern amateur athlete contests.  

I understand that the Metro Detroit Golden Gloves has exclusive rights to this competition and that any broadcast, reproduction, of the event without express written consent of the Metro Detroit Golden Gloves, is prohibited.
PLEASE NOTE; A $10.00 ENTRY FEE MUST ACCOMPANY THIS APPLICATION!! 
_____________________________  _______________________________  ________________________
    (Boxer’s coach or other witness)                          (Participant’s Signature)      (Date)               /        /        /
    (Parent or guardian signature if registered boxer is under 18 years of age)      (Date)               /       /        /