Get a Grip Application

Get A Grip Application

Please fill out all sections below
Application Form

*Youth must be at least 12 years old by start of program to apply.

**See our Privacy Policy for details on how we manage your information. We never share or sell your information.

***Our Terms and Conditions can be found HERE for your reference
Full name of applicant*

First NameLast Name
Age as of May 1 (year of program applying for):*
Applicant's Pronouns (select those that apply):*

She/HerHe/HimThey/ThemPrefer Not to AnswerOther
If applying before April 1: Would you also like to apply for our Take a Hike program (Dates: Tuesday and Thursday evenings in April). *If you indicate yes for this option, you will be considered for Get a Grip AND Take a Hike.*
Referral Source/How did you hear about us?*
Place of Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you identify as an individual within the BIPOC community? - All information will be kept confidential in accordance with federal law and does not affect your eligibility for our programs, we collect this information to provide participant demographics to our funders.

YesNoPrefer not to answer
If you answered 'yes' to the previous question, please select from list below:
Are you a first time rock climber?*
If you responded 'No' the previous question, please tell us how many days' experience you have and how long ago?
In your own words, please explain why you would like to participate in our Get a Grip program.*
Are you available on Tuesday and Thursday evenings in May (indoor climbs), as well as the last Saturday of May and first Saturday of June (full days, outdoors climbs at Skaha Bluffs)?*
Please list any known conflicts with these days:*
RENTAL INFORMATION: Please enter youth's height, weight, shirt and shoe size (for supply and rental purposes):*
Parent/Guardian Email Address (this is where we will send notice of acceptance into the program and program information once accepted)*
example@example.com
PICK UP LOCATION: Are you able to meet at one of our central pick-up locations - West Kelowna Xtreme Theatre parking lot (beside Dairy Queen), Orchard Park Mall (beside bus loop), Rutland Shell (Hwy 33 and Gerstmar), or Rutland 7-11 (Hwy 33 and Rutland Rd) for transport to the mountain?*
TYPE OF SPOT: Please indicate the type of spot you are applying for:*

Paid ($350/participant - invoice will be sent once participant has been accepted into the program)Scholarship (Free for eligible youth - please select from eligibility criteria below)Partial (if you do not meet any of our eligibility requirement for a full scholarship (listed below) but would like to inquire about partial support, please select this option and we will follow up with you to discuss options)
Please see eligibilty criteria below

If selecting eligibility criteria that requires documentation/proof of eligibility, please email 1 document to confirm eligibility to Programs@elevationoutdoors.ca (if you've selected multiple criteria that apply, you do not need to send documention for every one, choose the one that is easiest to provide).

To see the current Low Income Cut-Offs (LICO), click here and scroll down to 'Who We Serve'.
If you selected "Scholarship" for TYPE OF SPOT above, please select all that apply.

Parent/guardian or the youth are receiving social assistance *Proof of assistance requiredThe youth is involved with MCFD programs or is in foster care *Letter from social worker requiredThe youth is on parole, probation, or in a restorative justice program *Letter from office/case worker requiredThe youth is connected to a mental health clinician or practitioner *Letter from mental health worker required*The youth identifies as Indigenous (or Metis, First Nations, etc. - no proof necessary)Parent/Guardian living with the participant has income at or below the Low Income Cut-Offs *Proof of income requiredI do not meet any of these criteria, but still face financial barriers. I would like to be contacted about a Partial Scholarship.
GOOGLE CALENDAR SHARING AND JUMPSTART PERMISSION:

Elevation Outdoors has permission to share Google Cal dates with my and/or my child's email adress (leave blank below if not interested).
Parent/Guardian Email Address
example@example.com
Youth's Email Address
example@example.com
I give permission to Elevation Outdoors to contact me about future programs and opportunities that come available.*
I give permission for Elevation Outdoors to provide my contact information to the Canadian Tire Jumpstart Foundation. As partial funders for this program they like to be able to contact you directly with future opportunities.*
PHOTO AND VIDEO RELEASE - Parent/Guardian Signature

Clear
Elevation Outdoors has permission to use my or my child’s photograph/video/audio recordings to promote the organization. I understand that the images may be used in various formats not limited to print publications, online publications, presentations, websites,and social media.
CONTACTING YOUTH: Elevation Outdoors has permission to contact my child by phone (text or call) to confirm program attendance and to communicate with as need arises, during or between program dates. If you do not want this - leave this section blank.

Area CodePhone Number
Get a Grip Waiver

Please read all the information below - you will be sent a version of the waiver below that you will be required to sign upon acceptance into the program.
Dear parent or legal guardian, Elevation Outdoors is running our "Get a Grip" rocking climbing program this Spring for youth in the local area. The program involves teaching young people how to climb starting from an introductory level. The program will run primarily at Beyond the Crux Climbing Gym in Kelowna, with 1-2 trips to an outdoor climbing area with a certified guide from Hoodoo Adventures to go climbing outdoors. This letter is to inform you of the program and the expressed interest, as well as the inherent risks in the activity of climbing. Injury to participants is always a possibility when engaging in climbing. These risks include, but not limited to: falling, mechanical failure of the equipment; loss of balance or control; variable and difficult climbing conditions; collision with walls, climbing holds, exposed or hidden structural supports or beams or floor; rope abrasion, entanglement and other injuries resulting from activities on or near the climbing wall such as, but not limited to climbing, belaying, rappelling, lowering on ropes, rescue systems and other rope techniques; injuries resulting from falling climbers or dropped items, such as, but not limited to ropes, auto belays, climbing hardware or wall parts; failure of ropes, harnesses, slings, climbing holds, anchor points, or any part of the climbing wall; collision with other equipment or structures; collision with other persons; illness or trauma; the proximity of medical care which may or may not be readily available; the failure to act safely or within one’s own ability or to stay within designated areas; negligence of other climbers and/or other persons; and negligence on the part of Elevation Outdoors Experiential Programs Association or its staff and volunteers, including the failure on the part of Elevation Outdoors Experiential Programs Association or its staff to safeguard or protect from the risks, dangers and hazards of the activities. We are requesting that you fill out the form below stating that you have read and are aware of the inherent risks of this activity before your child is permitted to participate in the program. It is our intention to create a long-lasting, learning experience for the young people involved and we will be taking their safety very seriously.*
I have read the above statement and understand the inherent risks in the activity of rock climbing, we well as the risks of participating in the program.
Parent/Guardians Full Name*

First NameLast Name
Please Read and Sign - Parent/Guardians Signature*

Clear
I have read the above letter and understand the inherent risks in this activity, as well as the risks of participating in the program. I give my child permission to participate with this in mind.
Please Read and Sign - Participants Signature*

Clear
I have read the above letter and understand the inherent risks in this activity, as well as the risks of participating in the program. I give my child permission to participate with this in mind.
Participants Medical Form

Please fill out all the requested information
Participants Name*

First NameLast Name
Participants Date of Birth*

MonthDayYear
Date
Participants BC Care Card Number*
Please provide the correct care card number
Parent/Guardians Name*

First NameLast Name
Parent/Guardians Phone number - Provide preferred contact number*

Area CodePhone Number
Parent/Guardians Alternate Phone number - provide a second number to be reached at (Work, Home, Cell)

Area CodePhone Number
Emergency Contact - Provide who we should call in case we cannot reach you in case of emergencies.*

First NameLast Name
Emergency Contact Phone Number - Please provide the number of the person listed above.*

Area CodePhone Number
Medical History
Has you child ever suffered from Asthma?*
If Yes, please provide if they have medication and what it is/usage.
Does your child suffer from any allergies?*
If yes please list what they are and any medications they take, if it is anaphylactic and if they have an EpiPen.
Does your child suffer from any of the following?
Please select any/all that apply. Hold Cntrl or Command to select multiple entries.
Does your child suffer from any of the following?*

NonePhobiasEpilepsyDiabetesBleeding DisordersHeart ConditionsMigranes/HeadachesSeeing DisordersHearing DisordersKnee/Ankle/Joint ProblemsConcussions (current or historic)
If you selected any of the above options, please provide more information about them below.
Please let us know what the issue is/was, any medications they are on, and best practices for managing it.
When was the participants last Tetanus shot?*
Answer as accurately as possible. If not within the last 10 years, participant may receive a tetanus injection by a medical officer if they receive a tetanus prone wound.
Is your child on any ongoing medications?*
Please provide details of medications, dosage, and frequency taken.
If you answered yes to the above question, do you give permission to your child to self administer these medications?
If no please explain.
Please select any of the following non-prescription medications you give permission for your child to receive if needed.*
Hold Cntrl or Command to select multiple options.
Please select any of the following non-prescription medications you give permission for your child to receive if needed.*

Advil/Tylenol - pain/feverCold/Flu TabletsAntihistamine - bites/stings/allergiesNone
Does your child have any dietary restrictions (ie. vegan, vegetarian, gluten-free, dairy-free, allergies, etc.)?*
Please indicate "N/A" or "NONE" if none
Is there anything about your child's situation that we need to be aware of in regards to his/her participation in this program? Is there anything that may impact others in the program we need to be aware of?*
Example - Behavioural, Dietary, or Medical concerns
In the case of accident or illness, I authorize the caregiver to administer first aid and/or be taken to the nearest emergency centre. I consent for my child to receive medical treatment. I consent that in the event of severe injury or illness the means of transportation may be ambulance at a cost to myself.*
Parent/Guardian Signature*

Clear
I declare that the information which I have provided on this form is complete and correct and that I will notify the program if any changes occur. I authorize the facilitator who is with my child to consent, where it is impractical to communicate with me, for my child to receive such medical or surgical treatment as may be deemed necessary.
Date of Submission*

MonthDayYear
Date
This program is brought to you, in part, by:
Should be Empty:

Get A Grip Application

Get a Grip Waiver

Participants Medical Form

Medical History