Little Rock Climbing Center: Competition

Climbing Camp Registration Form

Child's Name:*
Date of Birth:*
Age:*
Parent/Guardian:*
E-mail:
Address:*
City:*
State:*		Zip:*
Home Phone:*
Work Phone:
Cell Phone:

Week ($120 per week):
June 23-27 (FULL) July 7-11 July 21-25 August 4-8
Allergies:
Medical Conditions :
Medications:
Emergency Contact:
Special Needs or Concerns:
Please pack a snack for your child and dress them in comfortable clothes. IMPORTANT NOTE: All climbers must have a signed LRCC waiver on file before participating. Minors must have waiver signed by a parent or guardian. *required fields