Paradox Rock | Gunks Trip 2024

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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*

I'd like to receive updates from this organization

We will never share your email address. Ever.

Cell Phone*

Date of Birth*

Gender*

Are you a Veteran?*

Yes No

Is this your first Paradox Sports event?*

Yes No

If you would like to be tagged in our Instagram or Facebook photos following the event, please let us know your social media handles here.

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Payment will be made on the final page.

Medical Information

Please select the category below that best describe your disability:

Disability Category*

Choose one... Developmental Disability (autism, cerebral palsy, etc) Non-disabled Hearing Impairment / Deaf Lower Limb Difference / Amputation 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?*

Yes No

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?*

Climbing Assistant Questions

If you are registering as a participant, you can skip to the next page.

Why would you like to volunteer for Paradox Sports?

Are you a certified Single Pitch climbing guide?

Yes No

Are you Climbing Wall Instructor (CWI) certified?

No Selection No, I am not CWI certified. CWI Top Rope Certified CWI Lead Certified CWI Provider

Please list any other AMGA Certifications you have:

If you work as a professional guide, please tell us where:

Do you have any Medical Training?

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Emergency Contact

Emergency Contact - Full Name*

Emergency Contact - Relationship to you*

Emergency Contact - Phone Number*

Do you have any questions or concerns prior to attending?

Is there anything else you would like us to know?

Waiver of Liability

You will be required to sign the Paradox Sports waiver before participating on program. Please review and sign the Trip Waiver and Media Release at bottom of the page at https://www.paradoxsports.org/trips/gunks/

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Payment will be made on the final page.

Complete Registration

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

Payment Type:

Credit Card

eCheck

PayPal

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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Complete Registration

Thank You!

Please check your email for a confirmation that your registration for Paradox Rock: Gunks Trip 2024 has been received. If you do not receive a confirmation email, please contact us.

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