Please complete the following registration form. Once the form is complete you will have the choice to make a payment online or send in a check by mail.
Registration forms will be processed only when team enrollment reservation fees have been completely paid. Team enrollment reservation will be applied to the overall coaching fee total. You will receive immediate confirmation within 24 hours.
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Select the program for this registration:
Club Team (7-10 yrs old)
Jr. Climbing Team (10-18 yrs old)
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| Name |
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| Nickname |
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| Address |
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| City, State, Zip |
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| Home Phone |
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| Cell Phone |
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| Email |
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| Age |
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Birthdate
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| School |
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| County |
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| School Grade |
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| Parent/Guardian's Name |
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| Parent/Guardian Cell Phone 1 |
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| Parent/Guardian Cell Phone 2 |
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| Parent/Guardian Email 1 |
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| Parent/Guardian Email 2 |
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| What extra-curricular activity are you involved in/when/what days of the week & time? |
Example: Soccer/Fall & Spring / Mon,Wed,Fri 3PM
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| What 2nd extra-curricular activity are you involved in/when/what days of the week & time? |
Example: Soccer/Fall & Spring / Mon,Wed,Fri 3PM
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| What 3rd extra-curricular activity are you involved in/when/what days of the week & time? |
Example: Soccer/Fall & Spring / Mon,Wed,Fri 3PM
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| Payment Information |
To fully commit to the fall Club Team or Jr. Team, complete the online registration form and submit payment of the non-refundable team enrollment registration fee. Or print the PDF registration form, select the one or two payment option and complete with a check made payable to ExperientialLife/UCC. WCRC membership is not included. All participants must arrange gym membership payment with WCRC prior to the first practice date. Please log on to their website to review payment options. Equipment and shoes are not included. Each team member must purchase their own equipment and shoes prior to the first team practice.
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| (Team Enrollment Reservation) Deposit Option |
Club Team $150
Jr. Climbing Team $150 |
| Full Payment Option |
Club Team $375
Jr. Climbing Team $375 |
| Total of Fees $ |
Note:
Please remember this total as you will need to fill it in when you click "buy now" on the next page. |
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