Youth Lead Climbing Verification Form
Verify a youth climber’s readiness and authorization for lead climbing participation. Please provide accurate participant, guardian, and climbing verification details.
Participant Information
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Parent/Guardian Name (if under 18)
Climbing Verification Details
Lead climbing experience level
*
Beginner
Intermediate
Advanced
Current lead climbing verification status
*
Not yet verified
Previously verified
Needs recheck
Belay certification or equivalent qualification status
*
Verified
Not verified
In progress
Date of most recent verification or assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency and Submission Details
Emergency Contact Name
*
First Name
Middle Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Climbing Gym or Verification Location
Acknowledgment
*
I confirm the information provided is accurate
I understand this form is for youth lead climbing verification
Submit
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