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Use this form to make changes to your youth program.

PROGRAM CONTRACT CHANGE FORM

 

Please note, if you are canceling your contract, the final billing date will be the 1st of the final month of participation. Enrollment will continue through the end of the month. Please be sure to cancel by the 10th of the month to avoid future charges.



  • This Youth Program Change Form is only applicable for ongoing school year programs and climbing team. To cancel your gym membership or ongoing adult class, please refer to our website or contact us for assistance.
  • If you are cancelling multiple participants out of youth program(s), please fill out a separate form for each participant. 
  • Youth Program Participants who choose the discounted paid in full trimester option have committed to the duration of that trimester and payment is non-refundable. If a participant chooses to cancel before the end of the trimester, cancellation will not result in refund or Vertical World credit. Please contact the Program Coordinator in case of unforeseen medical or family emergencies for program options.


Questions/Concerns? Please contact your gym's Program Coordinator:

Seattle: seattle-programs@verticalworld.com (206) 283-4497 

North: Anique@verticalworld.com (425) 609-9020

For all Climbing Team issues, please contact Tyson@verticalworld.com

 

The program coordinator will contact you if more information is needed.

 




First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Program Location (Home Gym):*
North
Seattle
Program Name:*
Rockin' Tots
Lil' Pebbles
Little Rockers
Base Club
Ascent Club
Summit Club
Homeschool Club
Climbing Team
Program Day:*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A // unknown
Desired Change:*
Cancel Program
Update Contact Info (use text box below)
Other (please use comment box below)

If you selected "Update Contact Info" or "Other" please elaborate here:
If cancelling a program, what is the last month you want to attend? Participants can only select their last month of participation as the current month if notice is given by the 10th. Program cancellation is never retroactive. *
N/A
September
October
November
December
January
February
March
April
May
June
If cancelling, please let us know why.*
N/A
Schedule Change
Sport Season Change
Finance Change
Other (please use comment box below)

If you selected "Other" please elaborate here:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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