December 27th 2019 to January 1st 2020 !!!

Joshua Tree California

Registration Form

name *

name

First Name

Last Name

email *

cell phone # *

cell phone #

(###)

###

####

In Case of Emergency

emergency contact *

emergency contact phone # *

emergency contact phone #

(###)

###

####

please list any allergies including insect bites, bee stings, foods, medications etc *

do you have any dietary restrictions:? *

Climbing, Yoga, & AcroYoga info

what is your perceived climbing level? *

tell us a bit about your climbing background.

if you don't have one that is fine just let us know. Also anything you would like to learn in terms of climbing can be added here

what is your perceived AcroYoga level? *

tell us a bit about your AcroYoga / Yoga background *

if you don't have one that is fine just let us know. Also anything you would like to learn in terms of AcroYoga/ Yoga can be added here

how did you find out about AcroRocks? *

Travel Plans

where are you coming from and how? *

*meaning by car, train, plane, or horse and buggy!

do you need a ride? if so from where?

If you are driving, can you provide carpool?

*please list how many seats in your car you have for people **please take into account their camping gear

will you be camping in your car? *

Rental Gear

*please check all that you need

Sleeping Bag $25

Sleeping Pad $10

Tent $30

Camping Chair $5

Climbing harness $10

Climbing shoes $10

climbing shoes size

*mark M for male and F for female. If you have never worn climbing shoes before or unsure, please put down your street shoe size and specify Street Shoe Size.

climbing harness size

*Pant waist size. please mark M for male and F for female

Fun Stuff

tell us 3 fun, interesting, and or strange facts about you related to this last year *

Payment

How would you like to pay

talk to us if this is an issue and if you need a payment plan etc.

RETREATER CONSENT AGREEMENT:

I agree that I am participating in an Yoga Squirrel Event, during which I will receive information and instruction about rock climbing, yoga, and AcroYoga. I recognize that both rock climbing and AcroYoga require physical exertion that may be strenuous and may cause physical injury; I am fully aware of and accept full personal responsibility for the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the rock climbing and yoga retreat. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the rock climbing and yoga retreat. In consideration of being permitted to participate in this climbing and yoga retreat, I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, past present or future, which I might incur as a result of participating in any climbing, hiking, yoga/AcroYoga practice, workshops and activities at the retreat. In further consideration of being permitted to participate in this climbing and yoga retreat, I knowingly, voluntarily and expressly waive any claim I may have against Yoga Squirrels, Casey Stroud, Sonia Peltzer and any of the staff, for any injury or death caused by their negligence or other acts. I have read the above release and waiver of liability and all terms and conditions and fully understand its contents. By checking the box below, I voluntarily agree to the terms and conditions stated above.

I voluntarily agree to the terms and conditions stated above.

todays date *

todays date

YYYY

AcroRocks New Years

December 27th 2019 to January 1st 2020 !!!

Joshua Tree California

Registration Form