Community Climb Registration You are registering for Climbing Center Community Climb on: 5-4-24. You are registering for Climbing Center Community Climb on: 5-4-24. Registration Name(Required) First Last Registration Email(Required) AddressPlease provide you address if you have not registered for a Community Climb Event before. If you have registered before, we will use your address linked with your email address. Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Phone number is required by state code for emergency contact.Participant List of Climbers (use "A" for adult in age field.)(Required)Please enter all people who will be climbing, including the person who is doing this registration if they are climbing. Use “A” for adults in the age field.NameAge Add RemoveThe following consent agreement only applies to people in your immediate family. Please use another registration for friends, children’s friends, extended family, or others who need a different consent agreement.Consent(Required)I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in, supervision if guardian of minor(s) and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by Phantom Ranch or its agents, employees, volunteers, or any other representatives (collectively referred to as the “sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association. My participation in the activity or event signifies my agreement to this waiver. I agree to the release of liability waiver for myself and anyone listed above.Choose fee option(Required)Maximum fees for families is $30. Individual fee is $10 per person. Choose “Family Package” for families, or select Individual and enter the number of people. Individual Family Package Individuals Quantity(Required)Enter the number of climbers. Price: $10.00 Quantity Family PackageMaximum fees for families is $30. Individual fee is $10 per person. Price: Total Payment Option(Required) Pay upon arrival Pay Now Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.
