Alpina Climbing Team Registration

Child Name *

First

Last

Child Birth Date *

Parent Name *

First

Last

Contact Requirement Child

Contact Phone Number *

Contact Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Prior Experience

Gym Membership Requirement *

I agree to the following: Payment for the class must be submitted by check within the first week of each month. This payment does not include a required membership to MetroRock ($75/month), which has to be purchased separately through the gym.