This is your standing record at the gym — one file that you and our staff keep current for as long as you climb here. It is not a per-visit form and it is never re-filled: certifications, grades, injuries and goals are amended in place as they change.
Preferred name / how it appears at the desk:
Second contact (if the first is unreachable):
Membership Status History
Add a row each time the plan changes — upgrade, downgrade, freeze, restart or cancellation. Keep the newest at the bottom so the history reads forward.
Belay & Lead Certification Log
Every check, re-check and lapse is recorded here by the certifying staff member. A certification is only valid while its most recent row says so.
Update a row whenever a new working or redpoint grade holds up over a few sessions — not after a single lucky send.
Standing conditions, finger and shoulder history, current rehab, anything a coach or first-aider should know before you tie in. Add dates so we can tell a healed injury from a live one.
Currently restricted from:
Rental shoe size / harness size:
Locker or gear-storage number:
Coaching Goals & Coach Notes
What are you training toward right now — a grade, a comp, an outdoor trip, a movement weakness?
Coach observations — technique patterns, strengths, things to keep working on. Dated entries, kept over time.
Notable sends, re-assessments, comps entered, courses completed, incidents on the mats — anything worth remembering next season. Newest at the top.
Certification cards from other gyms, medical clearance letters, coaching plans or comp registrations:
Keep this record current — it is what our staff read before they clear you for the wall.