Juniors & CC 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) *

What program(s) are you interested in? *

Junior Team: Wednesday 2:30 - 4pm WAITLIST
Junior Team: Wednesday 4:15 - 5:45pm WAITLIST
Junior Team: Thursday 4:15 - 5:45pm
Climbing Club: Monday 4:15 - 5:45pm WAITLIST
Climbing Club: Monday 6 - 7:30pm WAITLIST
Climbing Club: Tuesday 4:15 - 5:45pm WAITLIST

Wednesday 2:30 & 4:15pm Junior Team and all Climbing Club programs are FULL.

I have read over Rocknasium's youth program requirements & can confirm my child meets said requirements: *

I agree & my child meets said requirements
No I do not agree/my child does not meet said requirements

Junior Team: Participated in 2 or more kid climbs OR 1 week of summer camp within previous year ~~ Climbing Club: Graduating from junior team, participated in 2 or more kid climbs within previous year, OR 1 week of summer camp within previous year ~~ All participants are required to commit to full season.

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.

Phone