Chicks with Picks Sign Up
>> Click here to PRINT and MAIL in your sign-up form

>> SKIP THIS PAGE: If you are paying your final deposit, CLICK HERE

If you have any questions, please email Kim or call 970-626-4424.

CHICKS WITH PICKS ICE CLIMBING CLINIC SIGN-UP & QUESTIONNAIRE
STEP 1: Fill out Personal, Clinic/Level/Skills Day, Emergency, Insurance, Travel, Medical, & Fitness Information
STEP 2: Fill in the written questions section fully, proceed to next step
Visa MastercardSTEP 3: Select Clinic and Housing Option, submit

STEP 4: Fill in Billing Information and Credit Card info on the secure page, submit

Please read the CLINIC LEVELS page before filling out this form.

PERSONAL INFORMATION :
Name:   Email:
Address 1:   Age:
Address 2:   Birthday:
City:   Tshirt Size:
State:   Shoe Size:
Zip:   Occupation:
Home Phone:   Height:
Work Phone:   Weight:
Cell Phone:      
         
I would like to sign up for the following clinic: (PLEASE CHECK ONE)
THE SAMPLER
THE GRADUATE
THE QUICKIE

THE COMPLETE CHICKS
   

I would like to sign up for the following level: (PLEASE CHECK ONE)

Please read the CLINIC LEVELS before choosing! All clinics are 4:1 RATIO.

The following level choices are for all clinics:

#1 BEGINNING ICE CLIMBING
#2 INTERMEDIATE ICE CLIMBING
#3 ADVANCED ICE CLIMBING
#4 MIXED CLIMBING
#5 BEGINNING LEAD CLIMBING
#6 LEAD CLIMBING (Resume Required)

THE COMPLETE CHICKS - SKILLS DAY: Write your #1, #2 and #3 choice. We need at least three participants to run a workshop, it is possible you will get your second or third choice.
The skills day choices are for "The Complete Chicks" Clinic ONLY.
Enter 1,2 & 3 in the boxes on the left.
#1 RESCUE WORKSHOP
#2 MIXED CLIMBING TECHNIQUE
#3 ALPINE SKILLS AND AVALANCHE AWARENESS
#4 ICE CLIMBING

EMERGENCY CONTACT INFORMATION:
Name:   Relationship to you:
Home Phone:   Work Phone:
Cell Phone:      

INSURANCE INFORMATION: There are inherent risks in ice climbing. We require you to obtain health insurance prior to particpating!
Carrier:   City:
Policy #:   State:
Phone Number:   Address:
      Zip Code:
         

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 Time:
Airline:   Arrival Flight #:
Departure Date:   Departure Time:
Airline:   Departure Flight #:
         

MEDICAL INFORMATION: We recommend that you consult your physician regarding your participation in one of our ice climbing clinics. Please contact us if you have ANY questions regarding your ability to participate.
Do you have any medical conditions or limitations? 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 are you in? Pick one:
Excellent
Fair  
Above Average
Poor  
Average      
         
Please list the activities in which you participate in and the frequency of each activity.

OTHER QUESTIONS:
1) Please describe your previous ice climbing experience.
2) How many years have you ice climbed?
3) How many days total?
4) Where have you climbed?
5) List some climbs you've followed and their difficulty.
6) What difficulty ice have you led and how many? Please list climbs and the difficulty of the one's you have led.
7) What interests you most about the clinic?
8) What would you like to focus on?
9) Do you have any rock climbing experience?  Please explain.
10) Do you have any alpine climbing experience? Please explain.
11) How did you learn about the clinic?
12) If you are an alumnus, please list the year, guide and class level you participated in. 
13) We will have limited demo gear available for you to use though we suggest that you bring your own gear if you have it. Please list the gear you do NOT have (example: ice axes, crampons, boots, back pack or soft wear ). (see What to Wear page for specifics)
14) Do you have any concerns you would like to express?
15) Is there anything else you want to comment on?


PLEASE NOTE: The balance is due 30 days before the clinic date.
Reservation Policy
A non-refundable deposit for half the amount of the clinic cost is due at the time of booking. The balance is due 30 days prior to the clinic date.  If you register within 30 day’s of the clinic, the full amount is due upon registration.

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.

 

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