Rock Climbing Registration Form

First Name

Last Name

Date of Birth

Phone Number

Email

Street Address

City/Suburb

State/Province

Postal/Zip Code

Emergency Contact Name

Emergency Contact Phone Number

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

If yes, please specify.

Are you currently taking any medications?

If yes, please list them.

Do you have any allergies (e.g., to pollen, insects, or medications)?

If yes, please specify.

Do you have any fears or phobias (e.g., heights, falling, confined spaces)?

If yes, please describe.

What is your current level of physical fitness?

Do you engage in regular physical activity or exercise?

If yes, please describe your routine.

Have you ever taken a rock climbing course before?

If yes, please provide details (e.g., location, duration, level).

What type of rock climbing are you interested in?

What are your goals for this course?

Are you interested in obtaining any certifications (e.g., belay certification)?

Do you have your own climbing equipment?

If yes, please list the equipment you own.

Are you comfortable using provided equipment?

Do you have any preferences for the type of climbing environment (e.g., indoor gym, outdoor crag)?

What is your preferred schedule for the course?

How many hours per week can you dedicate to the course?

Do you have any time constraints or scheduling conflicts?

If yes, please specify.

Do you understand that rock climbing involves inherent risks, including the risk of injury or death?

Are you willing to follow all safety instructions and guidelines provided by the instructor?

Do you consent to emergency medical treatment if necessary?

Is there anything else you would like us to know about your background, goals, or concerns?