SBR Camp Enrollment

School Breaks Rock - Day CAMP ENROLLMENT

Please complete and submit one form per child at least 24 hours prior to your Camp session. Please only submit one form per child, even if they will be coming on consecutive days of day camps.
Camp Participant's Name*
ONE Participant per Registration form please.
Camp Type *
Gender*

FemaleMaleNon-Binary
Date of Birth (mm/dd/yy)*

MonthDayYear
Date
Age*
Address*
City*
State*
Zipcode*
Parent Contact*
Contact Phone*
Contact Email*
Health Information

If your child has any health concerns which we should be aware of, please list below and describe.
Allergies
Medical Conditions
Injuries, medical, or emotional considerations which might affect your participation:
Authorized Pickups:

The person picking up your child will be asked to show ID. Their name must be listed below in order for your child to be released from camp. If you need to add anyone to this list after submitting the form you may do so at drop off before the start of any camp day.
Authorized Pickups*
CONSENT:
I do give permission for my child to participate in the Inner Peaks Climbing Camp. I have informed Inner Peaks of any factors, medical or emotional, that my child has which may affect the ability of the instructors to provide for their needs. I do hereby give consent to Inner Peaks to treat any injury occurring on any climbing day, and seek definitive care if it is deemed necessary.

Inner Peaks reserves the right to use any photograph or other media taken by Inner Peaks to be used in Inner Peaks promotional materials, brochures and on the website.

CANCELLATION POLICY:

I understand that I may reserve my spot with Full Payment up to 24 hours prior to the day of camp.

Matthews location (704-844-6677)

South End location (980-242-3244)

Cancellation policy-

Cancellations made at least 2 weeks before the registered camp start date will be honored with a full refund.

Cancellations made within 2 weeks of the registered camp start date will not be refunded.
Signature*
Date*

MonthDayYear
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School Breaks Rock - Day CAMP ENROLLMENT

Health Information

Authorized Pickups: