Rock Gym Climbing Lesson/Class Request Form

Rock Climbing Class Registration Form

Registration is OPEN for the first session of 2025 Classes! Please wait for a ROSTER CONFIRMATION EMAIL from Managers Josh Miyares or Christian Kim to know that your child is confirmed in your requested class. Looking forward to having your kids in class for the first time or returning again!
Full Name (Parent name if registering child under 18)*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Type of Lesson

Private LessonClass
How many participants are you registering today? *
Please enter full legal name(s) and age(s) of participant(s):
Full Name of Participant #1*

First NameLast Name
Age of Participant #1*
Birthday of Participant #1*

MonthDayYear
Date
Full Name of Participant #2

First NameLast Name
Age of Participant #2
Birthday of Participant #2

MonthDayYear
Date
Additional Participants' Name(s) and Age(s): If you are registering more than 6 participants, please enter additional full names and ages (example: Jane Smith (13))
Please describe the climbing experience (if any) of the participant(s)?
What goals do you or the climber have for this experience?
Please select which days/times you are requesting. Select all that you are available for. 6 Spaces available per class. Once the 6 first sign ups have been confirmed, class will be marked FULL!*

Monday 3:15-4:30pm (Ages 5-8 / 5 week session / Intro to Climbing) CLASS FULLMonday 4:45-6:00pm (Ages 9-12 / 5 week session / Intro to Climbing) CLASS FULLFriday 3:15-4:30pm (Ages 5-8 / 5 week session / (Intermediate Climbing)Friday 4:45-6:00pm (Ages 9-12 / 5 week session / (Intermediate Climbing)Wednesday 3:15-4:30pm (Ages 5-8 / 12 week session / Intermediate Climbing)Wednesday 4:45-6:00pm (Ages 9-12 / 12 week session / Intermediate Climbing) CLASS FULLSaturday 10:30-11:45am (Ages 5-8 / 5 week session / Intro to Climbing)
How did you hear about our program?
Would you like to request financial aid?

YesNo
Session (Hidden)
Should be Empty:

Rock Climbing Class Registration Form

Please enter full legal name(s) and age(s) of participant(s):