Contact, Intake & Medical Form Kinley Aitken Guiding uses this information to tailor your day and keep you safe. Your answers are confidential. This form includes the ACMG Medical Information section; the liability waiver is a separate document. Which clinic or day is this for? Clinic / course * Select… General clinic / climbing day Multipitch / trad systems Climb Harder Gravity Masters (falling & belaying) Crack climbing Wide crack climbing Clinic date (if known) Your details Email * We use your email to match this form to your booking. Full name * Preferred pronouns Select… She/Her He/Him They/Them Other… Mobile phone * Mailing address Date of birth * Emergency contact & medical Emergency contact name * Relationship to you Emergency contact phone * Allergies, medical conditions or injuries that may affect your participation * Medications (and what they are for) Mental health history or concerns you'd like us to know about Family doctor & phone Medical insurance provider & policy/ID number Anything else health-related we should know? Climbing background Have you climbed before? * Yes No How long have you been climbing? Select… 1–2 years 2–5 years 5–10 years 10 years or more Describe your climbing experience (how you got into it, styles you prefer, what you enjoy most) What draws you to try a rock climb? (grading, star rating, rock quality, location, aesthetics, a partner's suggestion, etc.) How often do you climb? (days/week) Indoors 1–2 Indoors 3+ Outdoors 1–2 Outdoors 3+ What types of climbing have you done? Highest grade climbed in the past 2 years, by style Have you belayed in the past 2 years? Top rope Lead No Do you hold a current belay certification from a BC climbing gym? Top rope Lead No Have you ever trained for climbing? (coach, online program, etc.) Self-assessment Your strengths as a climber (mental and physical) Your areas for improvement (mental and physical) What do you find challenging about crack climbing? Have you ever projected a climb? (worked a route over time until leading it clean) Yes No If you have projected: what did you enjoy, and what did you find challenging? If not: any reason why, and would you be willing to try? Mindset Choose the option that best describes you, on average. Goals General climbing goals (styles, routes, grades, trips) Specific learning goals for this clinic / day Any specific questions you'd like addressed during the clinic? Gear Tick what you own. Not all of it is required — we'll let you know what to bring. If you need to borrow gear, give us your sizes: Harness size —XSS–MM–XLXXL Helmet size —S–MM–L Climbing shoe size (street size, note M or W) A few last things How did you hear about this clinic or about Kinley Aitken Guiding? Select… Word of mouthInstagramFacebook PosterGoogle searchOther… Future clinics you'd be interested in Crack climbing Trad skills Multipitch systems Falling clinic Redpoint clinic Training for climbing Injury prevention Rope solo Wide crack If something else, what would you like to learn? Add me to the mailing list (occasional updates & deals; unsubscribe anytime) Submit form Thanks — your form has been received. You'll get a confirmation by email.
