Rock Climbing Inquiry Form

First Name

Last Name

Date of Birth

Email

Phone Number

Street Address

City/Suburb

State/Province

Postal/Zip Code

Emergency Contact Name

Emergency Contact Phone Number

Have you ever rock climbed before?

If yes, please describe your experience level.

Have you climbed indoors or outdoors?

Approximately how many times have you climbed?

What type of climbing are you most interested in learning?

Are you comfortable with heights?

Have you ever experienced a fear of heights or vertigo?

Do you have any prior injuries or medical conditions that might affect your ability to participate in rock climbing?

If yes, please describe them in detail (This information will be kept confidential and used only to ensure your safety and well-being)

What type of climbing are you most interested in learning?

What is your preferred course format?

Are you interested in indoor or outdoor climbing courses?

What are your preferred days for a course?

First Choice

Second Choice

Third Choice

What are your goals for taking this course? (e.g., learn basic skills, improve technique, climb harder grades, enjoy the outdoors.)

Are you interested in certification courses?

Do you have any specific skills you would like to learn or improve?

What are your goals for taking this course? (e.g., learn basic skills, improve technique, climb harder grades, enjoy the outdoors.)

What are your preferred days for a course?

Do you regularly participate in any other sports or physical activities?

If yes, please list them.

Are you comfortable with moderate physical exertion?

Is there anything else you would like us to know about your climbing experience, goals, or any other relevant information?

How did you hear about our rock climbing courses?

Participant Signature