Middle School Mr. Pfanner, Rock Climbing & Functional Movement Enrichment Program 2021 Registration Form
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Students will be provided materials for the course as needed.

Description:  Time to rock & roll!  This exciting opportunity will teach kids the basics and safety of indoor rock climbing.  We will be starting with bouldering and progressing to top roping throughout the week.  In addition we will be using brand new equipment in our functional movement warm up!

This camp is perfect for anyone looking to climb the ladder with their rock climbing skills!



Teacher:          Thomas Pfanner
Dates:              August 9-13, 2021
Times:              11am-1pm
Location:          Arts & Technology Middle School
Grades:             5-8 (No Experience Needed)


Session Placement: Placement in each session will be done through a combination of self selection & current teacher recommendations.

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Email *
Student's LAST Name *
Student's FIRST Name
Student's 4J Identification Number
Middle School Student Will Be Attending in FA2021: *
What has motivated you to join this camp? *
What is your experience level with Rock Climbing?
Student Home Address: *
Example: 200 N Monroe St., Eugene, OR 97402
Parent / Guardian Last Name: *
Parent / Guardian First Name: *
Parent/Guardian Phone Numbers - Cell, Home, Work *
Please list all available numbers.                                                                                                                                                          Examples: 541-790-7700 (Cell)   541-790-7701 (Home)   541-790-7702 (Work)
Name of Emergency Contact : *
Emergency Contact Relationship: *
Example: Grandmother, Aunt, Family Friend, etc.
Emergency Contact Phone *
Example: 541-790-7700
Health Conditions: Please indicate if any of these or other conditions apply to your child.
Please indicate if your student is supported by
As appropriate, please provide more specific information on health conditions, including required accommodations.
If the student requires prescription medication while attending this Summer Intensive Course, please list.
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