Safe Passage Climb-A-Thon Registration
Event Date: Tuesday, November 28th, 2017 4:30-8:30pm
Event Address: CityROCK: 21 N Nevada Ave, Colorado Springs, CO 80903
Contact us at (719) 636-2460 or jbjurstrom@safepassagecac.org
Email address *
After hitting "submit", please follow the directions on the next page to make Paypal Donation. We appreciate your support!
Suggested Donation to Climb:
$40 + Pledges/Adult
$17+ Pledges/Child

Pledge to Your Limit: Ask friends and family to support you by pledging a donation!
Grandma could contribute $5 (or more!) per 10 ft (Adults) or 5 ft (Kids) climbed!

Not a Climber? That’s okay! Join us Anyway! ($60 Suggested Donation)

Phone Number *
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PARTICIPANT/Climber First Name *
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PARTICIPANT/Climber Last Name *
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Is the Participant 18yrs or Older? *
Required
Parent/Payer First & Last Name (If different from Participant)
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(Optional) Emergency Contact Name & Phone
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A copy of your responses will be emailed to the address you provided.
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