Team Rocknasium Request Form

Parent/Legal Guardian Name *

First

Last

Phone Number *

Email Address *

Please ensure this is an email you check often & you can respond to updates about your child's status on our youth programs promptly.

Climber(s) Name(s) *

Climber(s) Birthday (mm/dd/yy) *

My child meets the Team Rocknasium pre-requisites *

Graduated from climbing club (or experience in similar program at other gym)
Can pass or have passed Rocknasium lead climbing test (will learn to lead belay as part of team Rocknasium curriculum)

I agree to the Team Rocknasium membership requirements: *

Any additional information we should know about your climber(s)?

Do you have any questions?

A coach will reach out via email to address any specific questions you have regarding youth programs.

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