Paradox Rock | Gunks Trip 2021

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Your Information

In order to complete your application, please answer the questions below.

✓Contact Info

✓Medical Info

✓Climbing Info

✓Emergency Contact

✓Payment

Type of Program

Contact Information

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Country*

Email Address*

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Cell Phone*

Date of Birth*

Gender*

Are you a Veteran?*

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What unisex t-shirt size do you wear?*

Is this your first Paradox Sports event?*

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Medical Information

Please select the category below that best describe your disability:

Disability Category*

Choose one... Hearing Impairment / Deaf Lower Limb Difference / Amputation N/A Neurological Disorder Other Paralysis PTSD Spinal Cord Injury Traumatic Brain Injury (TBI) Upper Limb Difference / Amputation Visual Impairment / Blindness

Please provide any details on your disability here:

Do you use a mobility device?

Will you be bringing a service animal?

Yes No

Please describe any recent injuries or hospitalizations we should know about

Please list any mental or emotional conditions you are experiencing currently*

Please list any medications you will be bringing:*

Do you have any serious allergies requiring EpiPen or other medication?*

Do you have any food allergies or dietary restrictions?*

Briefly describe your current fitness level*

Do you have clearance from your Doctor to participate?*

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Height:*

Weight (lbs):*

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Climbing Experience

How would you rate your climbing level?*

Please elaborate on your climbing experience:

Climbing Details*

What are your goals for attending this event?*

Describe any experience you have with adaptive sports / organizations:*

Do you need to borrow climbing or camping gear for the event?*

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Emergency Contact

Emergency Contact - Full Name*

Emergency Contact - Relationship to you*

Emergency Contact - Phone Number*

Activity Risk Statement

All participants will be required to follow the Paradox Sports’ policies and procedures and will be required to sign a Participant Assumption of Risks, Acknowledgment of Inherent Risks and Indemnity Agreement before or upon their arrival. Please review and sign the trip waiver at bottom of the page at www.paradoxsports.org/trips/gunks

The programs we offer are adventurous and exhilarating outdoor activities that have inherent subjective and objective hazards and risks. Natural and man-made elements and equipment variables are inherent risks of participation. Incidents with these factors can result in serious or fatal injury.
As a participant, it is also important that you take responsibility for your own experience, as well as the experience of others.

Acknowledgment of Terms and Conditions

I acknowledge that participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.
I acknowledge that I am responsible for my transportation to/from the event.
I acknowledge that assistants and/or family members accompanying me, will be registered as a volunteer for the event at the full registration rate.
I acknowledge that I have read and understand the Paradox Sports activity risk statement above.
I acknowledge that I have medical clearance to participate in this climbing program.
I acknowledge the prerequisites including recommended fitness and climbing level.
I acknowledge that minors must be accompanied by an adult.
I acknowledge that in the event Paradox Sports is not able to accommodate my needs for any reason, I will receive a refund the registration fee in full.
I acknowledge and agree to the Paradox Sports Cancellation Policy:
• If you cancel 2 weeks or more before the event, you will receive a full refund of your registration fees unless costs were incurred by Paradox Sports; in that case, we may retain 10% of your registration fee.
• If you cancel less than 2 weeks before the event and we cannot fill your spot, you will be charged 50% of the registration fee.
• If you cancel without notice (no-show) your registration fee is non-refundable and we will retain the full fee.
• For cancellations due to emergency situations and special cases, please contact us to discuss options. We will work with you for the best solution.

I have read, understand, and agree to the above terms and conditions:

Agree*

No Selection I agree

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Complete Application

Do you have any questions or concerns prior to attending?*

Is there anything else you would like us to know?

Optional Donation

I would like to make an additional donation to Paradox Sports.

$10
$25
$50
$75
$100
$

I’d like to cover the fees so 100% of my registration fee goes directly to Paradox Sports.

Payment Details

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Bank Account*

Name on Account*

Bank Routing Number*

Bank Account Number*

Card Number*

Security Code*

Expiration Month*

Expiration Year*

Name on Card*

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