Youth Program Registration Form
"Crux Alone" Youth Program
(Leave your parents at home)

Registration Form for Climbers Age 10-13
Good for one year after date of registration

---To register your child for "Crux Alone" Youth Program, complete this registration form, the Crux Youth Program Pledge, (parent must be present to complete all necessary forms), and accompany this registration form with a $25 nonrefundable registration fee. If you wish to purchase an Iron Climb Vest (optional), an additional fee of $25 is required . Payment of the registration fee must be made prior to your child's first Youth Program visit . The registration fee entitles you to the "Crux Alone" Youth Program for one year beginning on the day you register.

First Name:____________________________________Last Name:___________________________________

Age:___________Birth Date:___________________

Parent / Guardian Name:___________________________________________________
First ---------------------------Last

Parent's Address:___________________________________________________________

City:________________________ State:______ Daytime phone # : (_____)_____-_______

Vest Size: Youth 10 Youth 14
Initial when vest is received: _________________

"Crux Alone" Youth Program Pledge
As a member of the "Crux Alone" Youth Program,
I___________________________________ pledge that:
  1. When I arrive at Crux, I will check in with a Crux Staff member at the front desk.
  2. I will stay within the boundaries of the Climbing Center and lawn area, and that I will never leave the premises without being accompanied by my guardian.
  3. I will never "free climb" above my body height or climb without a belay.
  4. I will adhere to the rules for use of all equipment provided for my use by Crux.
  5. I will show respect for myself, other climbers, the Climbing Center itself, and all equipment provided for my use by Crux.
  6. I will not use inappropriate language or behavior; I will respect the rights and possessions of others, and obey the rules set by Crux and the Crux Staff. Above all, as a member of Crux Iron Climb Program, I will meet new friends, share experiences and have loads of fun!!!

I realize that the following consequence will result if I break my pledge:
My parents will be notified that I will no longer be welcome in the "Crux Alone" Youth Program, and that there will be no refund of my registration fee.
Child's Signature: _____________________________ Parent's Signature: ______________________________