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Access2Climbing - Participant Application Form

Section 1 — About You (Participant)

First name

Last name

Date of birth

What city or town do you live in?

What school do you currently attend?

How did you hear about Access to Climbing?

A
B
C
D
E
F

Which session are you interested in?

Section 2 — Your Background with Sport and Climbing

Have you ever been rock climbing or bouldering before?

A
B
C

How would you describe your experience with sport or physical activity in general?

A
B
C
D

Is there anything that has stopped you from trying new sports or physical activities in the past?

Section 3 — Financial Eligibility

Access to Climbing sessions are free for all participants. To make sure we reach youth who face the greatest financial barriers, we ask a few questions about your household situation. Your answers are confidential and will not affect your experience at any session.

Does the cost of recreational activities like sports or gym sessions affect whether your family can participate?

A
B
C
D

Does your household receive any of the following?

Are you a newcomer to Canada (arrived within the last 5 years)?

A
B

Section 4 — Health and Safety

This information is used only to ensure we can provide a safe experience for all participants. It will not be shared outside the project team.

Do you have any medical conditions, injuries, or physical limitations we should be aware of before your session?

Do you have any allergies we should be aware of?

In case of emergency during a session, is there anything important we should know?

Section 5 — Parent or Guardian Information

Parent or guardian full name

Relationship to participant

A
B
C

Parent or guardian phone number

Parent or guardian email address

Emergency contact name (If different from above)

Emergency contact phone number (If different from above)

Communication preference

A
B
C
D

Ongoing contact permission

A
B
C

Section 6 — Consent and Agreement

I confirm that the participant named above is between 13 and 17 years of age and resides in Waterloo Region.

I understand that participation in Access to Climbing sessions requires signing two separate waivers before attending: the Access to Climbing Participant Waiver and the Grand River Rock facility waiver (available here). I agree to complete both waivers before the session date.

I understand that session spots are limited. If we are unable to attend, I will notify Access to Climbing at access2climbing@gmail.com at least 48 hours in advance so the spot can be offered to another participant.

Section 7 — Anything Else

Is there anything else you would like us to know about you or your interest in climbing?

Would you like to be added to our waitlist for future sessions if this one is full?

A
B