EWU DPT Adaptive Rock Climbing Waiver and Medical History Intake Form
Thank you for your interest in the Adaptive Climbing Program! We are excited to offer this program FREE of charge thanks to a grant received by Spokane Rotary Club #21!

Please read and complete the form to the best of your ability. This helps our physical therapist team screen each potential participant to ensure safe participation and therapeutic benefit from the program. 

Expected Outcomes for Participants:
  1. Climbers will receive free physical therapy with rock climbing as a primary treatment method for the duration of the program. This will be performed by 2nd year students from the Eastern Washington University (EWU) Doctor of Physical Therapy (DPT) Program and supervised by a licensed physical therapist. 
  2. Appointments are once a week, scheduled on Thursday afternoons between 2 and 6 pm (specific times will be scheduled and are about 90-120 minutes in length).
  3. Participants will improve their rock climbing comfort upon completion of the class and will learn the skills to participate in rock climbing at Wild Walls without the supervision of the EWU adaptive climbing program as they are able.
  4. Designated family members or close friends of the climber will be certified to belay and climb in Wild Walls if desired.
  5. Climbers will participate in supplemental activities and exercises to improve their physical ability to participate in rock climbing. 
  6. Note: Climbers who are minors or do not have cognitive capacity MUST have a parent/guardian/caregiver present while participating in this adaptive climbing program.
Program Eligibility:
  1. Neuro-musculoskeletal condition that impacts ability to participate in rock climbing due to physical disability.
  2. Interest in rock climbing.
  3. Understanding this activity will be used as physical therapy treatment, and comes with risks.
  4. Comfort with receiving treatment from student physical therapists under the supervision of a licensed physical therapist.
  5. Comfort with heights or comfortable trying to increase tolerance to heights using a rope with a safe environment is ensured by the student physical therapists and Wild Walls staff.
  6. Willing to commit to the full five-week program.
Program Exclusion Criteria:
  1. Told by your medical team that it is unsafe to participate in rock climbing due to a medical condition.
  2. Do not have a neuro-musculoskeletal condition that is appropriate for physical therapy intervention.
  3. Unable to commit to the full five-week program.

Once you have submitted this form, a member of the EWU DPT Adaptive Climbing program will reach out to you via email or text to further discuss the program and to help answer questions.

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