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The Jumping Off Place
phone: (503) 265-9551
phone: (503) 706-0233

info@thejumpingoffplace.com

“It’s hard to put a price on growth… [This class is] priceless”
—Student class evaluation, winter 2007

 



Register

email us: info@thejumpingoffplace.com
phone: 503.706.0233
phone: 503. 265.9551
or fill out the form below:

First Name:
Last Name:
Nickname:
Home Phone:
Cell Phone:
Email:
Address:
Mode of Payment: Unsure, will contact for more information
Weekly Payment Plan
Pay In Full ($120)
Prior arrangement with Instructor
Session:

Unsure, will contact for more information
Winter Session
Summer Session
Fall Session

Have you had any Injuries/Illnesses:
How Recent are any of the above injuries/illnesses?:

First Emergency Contact Information:

First Name:
Last Name:
Relationship to you:
Phone:
Address:

Second Emergency Contact Information:
First Name:
Last Name:
Relationship to you:
Phone:
Address: