SIGN UP

Chicks Rock Registration Form - Step 1

STEP 1: Fill out Personal, Medical, Insurance & Fitness Information
STEP 2: Select the Clinic of interest by filling in a number next to the option of your choice.
STEP 3: Fill in information and credit card info on the secure page. You will be making a 50% deposit by clicking submit.

*Be sure to fill out ONE form per person

First Name
Last Name
Address
City	State
Zip
Country
Email
Work Phone
Home Phone
Cell Phone

Personal Information:

Age: Birth Date:

Occupation:

T-Shirt Size: Shoe Size:

Height: Weight:

Emergency Contact Information:

Name:

Relationship to you:

Day Phone: Night Phone:

Insurance Information: Please fill out completely!

There are inherent risks involved in rock climbing.
We HIGHLY recommend that you obtain health insurance prior to participating.

Insurance Carrier:

Policy Number:

Company Phone:

Company Complete Address:

Travel Information:

We are not responsible for cancellation fees or costs arising from your changed or cancelled flights, lodging, or other arrangements. We recommend obtaining trip cancellation insurance from your travel agent.

Airport:

Arrival Date & Time:

Airline & Flight Number:

Departure Date & Time:

Airline & Flight Number:

Medical Information:

We recommend that you consult your physician regarding your participation
in one of our rock climbing clinics. Please contact us if you have ANY questions
regarding your ability to participate.

Do you have any medical conditions? If so, please explain:

Are you taking any medications? Please list and explain:

Do you have any past or present injuries? If so, explain

Are you pregnant?

If so, how many months?

Do you have any food allergies or restrictions? If so, what are they?

Are you a vegetarian?

Fitness Information: To fully enjoy and benefit from our clinics, we recommend an average level of fitness or above. Consult with your physician if you have any concerns.

What kind of physical condition would you say you are in?
excellent above average average fair poor

Please list the activities in which you participate in and the frequency of each activity.

CHICKS ROCK!

I will be signing up for the following rock climbing clinic:

Girly Gatherings

Adirondacks, New York
New River Gorge, West Virginia

Devil's Lake, Wisconsin

Full Package
Daytime Package (Guiding only)

Note: The group campground is included in the price of the full package clinic for Devil’s Lake. If you choose to stay in a hotel, but want to join us for dinners and evening slideshows, sign up for the "full package" - the clinic price remains the same.

Red Rocks, Nevada

Spring Fall

Preferred lodging for Red Rocks:
Hotel Camping Not Applicable

For hotel & lodging options see our Travel Info page on our web site

Transport Information:
Will you be renting a car that can be used to transport other participants to the climbs?
Yes No
*If not, you will be responsible to get yourself to and from the climbs. We will email participant contact info so you can coordinate rides.

Clinic Levels:
Level 1- Beginning
For those with minimum or no rock experience

Focus On:

knots and belaying and gear
lowering and rappelling
focus on footwork, technique for easy slabs, sport, and cracks

Level 2 - Intermediate
For those who are comfortable top roping up to 5.9

Focus On:

review of knots and belaying
focus on footwork, technique for intermediate slabs, sport, and cracks
intro to anchors

Level 3 - Advanced Intermediate
For those who can top rope 5.8-5.10

Focus On:

build top rope anchors
be a good second on multi-pitch climbs
more advanced movement skills on steeper routes

Level 4 - Advanced
For those who are breaking in to the 5.10 level

Focus On:

clean anchors to lower off
focus on conserving energy, resting, and reading sequences
intro to protection placement
self-rescue and belay escape

Level 5- Intro to Leading
Must be able to follow 5.10a clean (no falls or hangs)

Focus On:

practice leading (may be on a loose top rope or not); get critiqued on gear placement and overall safety
work on anchors and systems that pertain to leading
strategies for on-sighting and red-pointing
self-rescue and belay escape

WHICH CLINIC LEVEL IS FOR YOU?
Please indicate the clinic level of your choice*:
Level 1 - Beginning - For those with minimum or no rock experience
Level 2 - Intermediate - For those comfortable top roping up to 5.9
Level 3 - Advanced Intermediate - For those who can top rope 5.8-5.10
Level 4 - Advanced - For those who are breaking in to the 5.10 level
Level 5 - Intro to leading - Must be able to follow 5.10a clean (no falls or hangs)

*(This does NOT APPLY to the Devil's Lake Coed Weekend Skill's Clinic only)

Other Questions:

Please fill this out thoroughly so we can place you in the appropriate group

1) Please describe your previous rock climbing experience.

2) How many years have you rock climbed?

3) How many days total?

4) Where have you climbed?

5) List some climbs you've followed and their difficulty. Sport or trad?

6) If you are taking the lead class, list the climbs you have led and their difficulty.

7) We will have limited demo climbing gear available (helmets, harnesses, climbing shoes), though we request you bring the above items if you have them. Please list the gear you do NOT have.

8) What interests you most about the clinic?

9) What would you like to focus on?

10) How did you learn about the clinic?

11) If you are an alumnus, please list the year/s and your guides.

12) Do you have any concerns you would like to express?

13) Is there anything else you want to comment on?

Enter Security Code:

Reservation Policy
Payment for the cost of the clinic is due at the time of booking.

Cancellation Policy
30 days or more before clinic: Half of full tuition will be refunded.
Between 14 and 30 days before clinic: One quarter of full tuition will be refunded.
14 days or less before clinic: No tuition will be returned.

Please Note: We are sorry but no exceptions will be granted from this policy, including injury, illness or family emergencies.

* We highly recommend that you obtain travel insurance to recover your deposit and/or flight if you have an unexpected life occurrence and cancel.